Provider Demographics
NPI:1982879680
Name:DILLER, ANDREW J (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:DILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 PARK EAST DR.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4337
Mailing Address - Country:US
Mailing Address - Phone:216-245-1290
Mailing Address - Fax:866-571-4884
Practice Address - Street 1:3733 PARK EAST DR.
Practice Address - Street 2:SUITE 240
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4337
Practice Address - Country:US
Practice Address - Phone:216-245-1290
Practice Address - Fax:866-571-4884
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3545213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3142601Medicaid
OH3142601Medicaid
OH3142601Medicaid