Organization
JOSEPH A FAVAZZO DPM LL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ANGELO FAVAZZO DPM (OWNER)
(330) 963-4880
Entity
Organization
Contact information
Practice address
8984 DARROW ROAD, STE 2, TWINSBURG, OH 44087
(330) 963-4880
(440) 461-3279
Mailing address
8984 DARROW ROAD, STE 2, TWINSBURG, OH 44087
(330) 963-4880
(440) 461-3279
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36-003320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2406524
—
OH
01
—
5315240001
DMERC
OH
01
—
J09334871
MEDICARE GROUP NUMBER
OH
01
—
P00044963
MEDICARE RAILROAD
OH
Enumeration date
10/24/2007
Last updated
01/03/2008
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