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NPI Code Detail

MEDICARE: MADISON LEE PODIATRY, INC

MEDICARE: MADISON LEE PODIATRY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist2576OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336468446
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON LEE PODIATRY, INC
Provider Business Mailing Address
First Line : 6502 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-3014
Country : US
Telephone Number : 216-631-6080
Fax Number : 216-651-5002
Provider Business Practice Location Address
First Line : 6502 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-3014
Country : US
Telephone Number : 216-631-6080
Fax Number : 216-651-5002
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT THOMAS PORTNOW
Credential : D.P.M.
Telephone Number : 216-631-6080
Provider Enumeration Date : 05/28/2010
Last Update Date : 07/01/2010

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Directions to “MADISON LEE PODIATRY, INC ” Practice Location

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