MEDICARE: BARRY A KOBLENTZ DPM INC

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	1541	OH

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	:	1982616835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY A KOBLENTZ DPM INC

Provider Business Mailing Address
First Line	:	5035 MAYFIELD RD
Second Line	:	215
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-291-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5035 MAYFIELD RD
Second Line	:	215
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-291-1515
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY ALAN KOBLENTZ
Credential	:	DPM
Telephone Number	:	216-291-1515

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	12/10/2007

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