Provider Demographics
NPI:1962549352
Name:WESTLAKE FOOT AND ANKLE CLINIC, INC.
Entity type:Organization
Organization Name:WESTLAKE FOOT AND ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-835-1999
Mailing Address - Street 1:29101 HEALTH CAMPUS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5266
Mailing Address - Country:US
Mailing Address - Phone:440-835-1999
Mailing Address - Fax:440-835-1996
Practice Address - Street 1:29101 HEALTH CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5266
Practice Address - Country:US
Practice Address - Phone:440-835-1999
Practice Address - Fax:440-835-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3600169T213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0520305Medicaid
OHSP02111Medicare PIN
OHT80498Medicare UPIN
OH0520305Medicaid