MEDICARE: CLEVE RICHARD PILAKOWSKI D.P.M.

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	00657	IA
2	213E00000X	Podiatrist	12-00392	KS

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
2	10372	OTHER	IA	WELLMARK PROVIDER NUMBER

General Provider Information

NPI Number	:	1689663627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEVE RICHARD PILAKOWSKI D.P.M.

Provider Business Mailing Address
First Line	:	4102 W 6TH ST STE A
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4626
Country	:	US
Telephone Number	:	910-795-6029
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 W 6TH ST STE A
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4626
Country	:	US
Telephone Number	:	910-795-6029
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	03/10/2026

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