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General NPI Number Information
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NPI Number | 1245357771
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Entity Type | Organization
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Legal Business Name | NORTH SHORE PODIATRY INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 515 MOORE RD SUITE 3
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City | AVON LAKE
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State | OH
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Zip | 44012-2366
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Country | US
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Telephone | 440-930-8637
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Fax |
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Provider Business Mailing Address
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Address Line | 515 MOORE RD SUITE 3
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City | AVON LAKE
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State | OH
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Zip | 44012-2366
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Country | US
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Telephone | 440-930-8637
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Fax |
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Authorized Official
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Title or Position | PODIATRIST OWNER
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Name | PAUL SHEARER
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Credential | DPM
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Telephone | 440-930-8637
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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 | 36003128
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License Number State | OH
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