Provider Demographics
NPI:1851056204
Name:NORTH CANTON PODIATRY INC
Entity Type:Organization
Organization Name:NORTH CANTON PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-494-4949
Mailing Address - Street 1:8328 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4820
Mailing Address - Country:US
Mailing Address - Phone:330-494-4949
Mailing Address - Fax:
Practice Address - Street 1:8328 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4820
Practice Address - Country:US
Practice Address - Phone:330-494-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822015Medicaid