Healthcare Provider Details

I. General information

NPI: 1669439105
Provider Name (Legal Business Name): MARK L NOSIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 WARRENSVILLE CENTER ROAD SUITE 104
UNIVERSITY HEIGHTS OH
44118
US

IV. Provider business mailing address

2245 WARRENSVILLE CENTER ROAD SUITE 104
UNIVERSITY HEIGHTS OH
44118
US

V. Phone/Fax

Practice location:
  • Phone: 216-932-3668
  • Fax: 216-901-9958
Mailing address:
  • Phone: 216-932-3668
  • Fax: 216-901-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2625
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000699
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: