Provider Demographics
NPI:1730167156
Name:TRIAD FOOT AND ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:TRIAD FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-226-9108
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-0093
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:440-777-6940
Practice Address - Street 1:15644 MADISON AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:216-226-9108
Practice Address - Fax:216-226-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA5380OtherRR MEDICARE
OH9335762Medicare PIN
OH9335763Medicare PIN
9335761Medicare PIN