Provider Demographics
NPI:1922527118
Name:NORTHEAST OHIO FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHEAST OHIO FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:LUCKINO FOOT & ANKLE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-477-6265
Mailing Address - Street 1:4900 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7483
Mailing Address - Country:US
Mailing Address - Phone:330-477-6265
Mailing Address - Fax:330-477-6306
Practice Address - Street 1:4900 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7483
Practice Address - Country:US
Practice Address - Phone:330-477-6265
Practice Address - Fax:330-477-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003689213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty