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General NPI Number Information
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NPI Number | 1043215817
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Entity Type | Individual
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Provider Name | LAURENCE W SPIVACK DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9330 HIDDEN GLEN DR
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-487-3947
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Fax | 513-858-7827
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Provider Business Mailing Address
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Address Line | 9330 HIDDEN GLEN DR
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City | MENTOR
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State | OH
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Zip | 44060-7362
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Country | US
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Telephone | 440-487-3947
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Fax | 513-858-7827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36001535
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License Number State | OH
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