Healthcare Provider Details

I. General information

NPI: 1063401727
Provider Name (Legal Business Name): JEFFREY D LUBELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 222ND ST
EUCLID OH
44123-2032
US

IV. Provider business mailing address

628 E 222ND ST
EUCLID OH
44123-2032
US

V. Phone/Fax

Practice location:
  • Phone: 216-731-8052
  • Fax: 216-731-1855
Mailing address:
  • Phone: 216-731-8052
  • Fax: 216-731-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-2220-L
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-00-2220-L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: