Avon Lake Podiatry Inc
Organization Active NPI Foot & Ankle Surgery Podiatrist · Avon Lake, OH
NPI 1992864490 · NPPES record last updated May 29, 2008
Key facts
- NPI
- 1992864490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 36.002416 (OH)
- Legal business name
- AVON LAKE PODIATRY INC
- Practice address
- 32730 Walker Rd
Suite I-3
Avon Lake, OH 44012-4100 - Phone
- (440) 933-4021
- Fax
- (440) 933-7132
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark David Gould, DPM
- Title
- President
- Phone
- (440) 933-4021
Practitioners 1
-
Mark David Gould, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101102000505 | OH | Part B Supplier - Clinic/Group Practice | 3173642758 |
Receives reassigned benefits from 1 practitioner Practice locations: Avon Lake, OH |
National Provider Directory
Locations
32730 Walker Rd
Ste I3
Avon Lake, OH 44012
Phone (440) 933-4021
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | 36.002416 | OH | Yes |
Addresses
Primary practice location
32730 Walker Rd
Suite I-3
Avon Lake, OH 44012-4100
Mailing address
32730 Walker Rd
Suite I-3
Avon Lake, OH 44012-4100
Phone (440) 933-4021
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480004004 | Other | OH | RAILROAD MEDICARE |
Other providers in Avon Lake, OH
- Ash Behavioral Consulting, LLC
- Marharyta Ataman
- Aurelia Group, LLC
- Avon Lake Back & Neck, Inc.
- Avon Lake City Schools
- Hannah M Bacon
- Darlene Baron
- Claudia Kay Bevan
- Amber Biacsi
- Jennifer Marie Birk
All providers in Avon Lake, OH · Foot & Ankle Surgery Podiatrist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.