Healthcare Provider Details

I. General information

NPI: 1487626396
Provider Name (Legal Business Name): MICHAEL J SHLONSKY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE WL30
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE WL30
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 440-899-5555
  • Fax:
Mailing address:
  • Phone: 440-899-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.002107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: