Organization
GRADY PODIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK GRADY (DPM)
(440) 478-9434
Entity
Organization
Contact information
Practice address
20800 WESTGATE MALL, SUITE 401, FAIRVIEW PARK, OH 44126-1323
(440) 333-7722
Mailing address
20800 WESTGATE MALL, SUITE 401, FAIRVIEW PARK, OH 44126-1323
(440) 333-7722
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061549
—
OH
Enumeration date
02/28/2012
Last updated
03/22/2016
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