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General NPI Number Information
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NPI Number | 1336468446
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Entity Type | Organization
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Legal Business Name | MADISON LEE PODIATRY, INC
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 6502 DETROIT AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-3014
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Country | US
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Telephone | 216-631-6080
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Fax | 216-651-5002
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Provider Business Mailing Address
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Address Line | 6502 DETROIT AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-3014
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Country | US
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Telephone | 216-631-6080
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Fax | 216-651-5002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT THOMAS PORTNOW
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Credential | D.P.M.
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Telephone | 216-631-6080
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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 | 2576
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License Number State | OH
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