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General NPI Number Information
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NPI Number | 1649467549
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PODIATRY CENTER, INC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 1502 LEAR INDUSTRIAL PKWY SUITE 1A
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City | AVON
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State | OH
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Zip | 44011-1379
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Country | US
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Telephone | 440-937-5400
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Fax | 440-937-5533
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Provider Business Mailing Address
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Address Line | 1502 LEAR INDUSTRIAL PKWY SUITE 1A
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City | AVON
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State | OH
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Zip | 44011-1379
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Country | US
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Telephone | 440-937-5400
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Fax | 440-937-5533
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Authorized Official
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Title or Position | PHYSICIAN/OWNER/PRESIDENT
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Name | DR. KAREN MARTINKO
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Credential | DPM
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Telephone | 440-937-5400
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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 | 0H 3122
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License Number State | OH
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