MEDICARE: SEVILLE PODIATRY SERVICES LLC

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

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	:	1659160281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVILLE PODIATRY SERVICES LLC

Provider Business Mailing Address
First Line	:	6392 EQUESTRIAN TRL
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7421
Country	:	US
Telephone Number	:	330-975-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	6392 EQUESTRIAN TRL
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7421
Country	:	US
Telephone Number	:	330-975-0004
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JONATHAN M. MOSS
Credential	:	DPM
Telephone Number	:	714-404-5641

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	03/02/2026

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Directions to “SEVILLE PODIATRY SERVICES LLC ” Practice Location

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