Provider Demographics
NPI:1972629855
Name:CLEVELAND FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:CLEVELAND FOOT AND ANKLE CLINIC
Other - Org Name:CLEVELAND FOOT AND ANKLE INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:MELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-231-3300
Mailing Address - Street 1:13951 TERRACE RD FL 6
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4308
Mailing Address - Country:US
Mailing Address - Phone:216-761-8661
Mailing Address - Fax:216-761-2376
Practice Address - Street 1:13951 TERRACE RD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4308
Practice Address - Country:US
Practice Address - Phone:216-761-8661
Practice Address - Fax:216-761-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH5179OtherRR MEDICARE
OH4315000002Medicare NSC
OHCH5179OtherRR MEDICARE
OH1563848Medicare PIN