Healthcare Provider Details

I. General information

NPI: 1770594467
Provider Name (Legal Business Name): JOAN ELLEN SCHILLER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18599 LAKE SHORE BLVD SIUTE 300
EUCLID OH
44119-1093
US

IV. Provider business mailing address

18599 LAKE SHORE BLVD SIUTE 600
EUCLID OH
44119-1093
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-6090
  • Fax: 216-383-5371
Mailing address:
  • Phone: 216-383-6090
  • Fax: 216-383-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002525S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: