Provider Demographics
NPI:1295079085
Name:NORTH EASTERN OHIO PODIATRY GROUP LLC
Entity type:Organization
Organization Name:NORTH EASTERN OHIO PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUKH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-953-3668
Mailing Address - Street 1:35010 CHARDON RD
Mailing Address - Street 2:SUITE #101A
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9010
Mailing Address - Country:US
Mailing Address - Phone:440-953-3668
Mailing Address - Fax:
Practice Address - Street 1:99 NORTHLINE CIRCLE
Practice Address - Street 2:SUITE #200
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1481
Practice Address - Country:US
Practice Address - Phone:440-953-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty