MEDICARE: DR. NANCY A DOMANOWSKI DPM

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
1	213E00000X	Podiatrist	36-003237	OH

General Provider Information

NPI Number	:	1366523276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY A DOMANOWSKI DPM

Provider Business Mailing Address
First Line	:	9823 LAKE AVE APT 207
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1200
Country	:	US
Telephone Number	:	216-281-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	14401 SNOW RD STE 102
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	216-267-0304
Fax Number	:	216-267-1077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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