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General NPI Number Information
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NPI Number | 1740736818
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Entity Type | Organization
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Legal Business Name | PROVIDERCARE LLC
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 23250 CHAGRIN BLVD STE 150
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City | BEACHWOOD
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State | OH
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Zip | 44122-5417
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Country | US
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Telephone | 216-402-0027
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Fax | 330-574-1050
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Provider Business Mailing Address
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Address Line | 23250 CHAGRIN BLVD STE 150
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City | BEACHWOOD
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State | OH
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Zip | 44122-5417
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Country | US
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Telephone | 216-402-0027
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Fax | 330-574-1050
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Authorized Official
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Title or Position | PODIATRIST
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Name | MARC A BERKOWITZ
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Credential | DPM
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Telephone | 216-392-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 347002808C
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 36003471
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License Number State | OH
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