Provider Demographics
NPI:1720306194
Name:DR JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC
Entity Type:Organization
Organization Name:DR JAMES BANGAYAN FOOT & ANKLE SPECIALTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-842-6781
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-842-6781
Mailing Address - Fax:440-842-6797
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-842-6781
Practice Address - Fax:440-842-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003437213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3143208Medicaid
OH9391791Medicare PIN
OH3143208Medicaid
OH4187873Medicare PIN