MEDICARE: DR. MARY THERESA SCHUH-CLARK 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	213ES0103X	Foot & Ankle Surgery Podiatrist	E5996	CA
2	213EP1101X	Primary Podiatric Medicine Podiatrist	E5996	CA
3	213E00000X	Podiatrist	E5996	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1376549022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY THERESA SCHUH-CLARK DPM

Provider Business Mailing Address
First Line	:	1990 WESTWOOD BLVD STE 220
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4674
Country	:	US
Telephone Number	:	310-475-5377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 WESTWOOD BLVD STE 220
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4674
Country	:	US
Telephone Number	:	310-475-5377
Fax Number	:	310-446-1825

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/23/2025

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