Provider Demographics
NPI:1447031430
Name:LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
Entity type:Organization
Organization Name:LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-357-8418
Mailing Address - Street 1:7482 CENTER ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5847
Mailing Address - Country:US
Mailing Address - Phone:440-357-8418
Mailing Address - Fax:440-255-9400
Practice Address - Street 1:15644 MADISON AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:216-221-2445
Practice Address - Fax:440-255-9400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY FOOT & ANKLE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty