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General NPI Number Information
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NPI Number | 1154514032
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Entity Type | Organization
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Legal Business Name | MIDWEST FOOTCARE, INC.
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 245 STOCKSDALE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-1563
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Country | US
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Telephone | 937-642-9936
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Fax | 937-642-5537
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Provider Business Mailing Address
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Address Line | 245 STOCKSDALE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-1563
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Country | US
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Telephone | 937-642-9936
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Fax | 937-642-5537
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Authorized Official
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Title or Position | CEO
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Name | DR. LEWIS MICHAEL VICHINSKY
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Credential | D.P.M.
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Telephone | 937-642-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36-00-1774-V
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License Number State | OH
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