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Organization

AVON LAKE PODIATRY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK DAVID GOULD DPM (PRESIDENT)
(440) 933-4021
Entity
Organization

Contact information

Practice address
32730 WALKER RD, SUITE I-3, AVON LAKE, OH 44012-4100
(440) 933-4021
(440) 933-7132
Mailing address
32730 WALKER RD, SUITE I-3, AVON LAKE, OH 44012-4100
(440) 933-4021
(440) 933-7132

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36.002416
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
480004004
RAILROAD MEDICARE
OH
Enumeration date
12/08/2006
Last updated
05/29/2008
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