MEDICARE: DR. ATTA J ASEF 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	36-00-2887A	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000122928	OTHER	OH	ANTHEMBCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881626646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATTA J ASEF DPM

Provider Business Mailing Address
First Line	:	35010 CHARDON ROAD
Second Line	:	SUITE #101A
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9011
Country	:	US
Telephone Number	:	440-953-3668
Fax Number	:	440-953-3556

Provider Business Practice Location Address
First Line	:	35010 CHARDON ROAD
Second Line	:	SUITE #101A
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9011
Country	:	US
Telephone Number	:	440-953-3668
Fax Number	:	440-953-3556

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/21/2022

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