Provider Demographics
NPI:1902103898
Name:FANNIN PODIATRY LLC
Entity Type:Organization
Organization Name:FANNIN PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FANNIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-468-6222
Mailing Address - Street 1:315 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1923
Mailing Address - Country:US
Mailing Address - Phone:419-468-6222
Mailing Address - Fax:419-468-8259
Practice Address - Street 1:315 N MARKET ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1923
Practice Address - Country:US
Practice Address - Phone:419-468-6222
Practice Address - Fax:419-468-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002701213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty