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General NPI Number Information
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NPI Number | 1942489257
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Entity Type | Organization
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Legal Business Name | LAKEWOOD AMBULATORY FOOT CEN
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 3386 WARREN ROAD
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City | CLEVELAND
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State | OH
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Zip | 44111-0000
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Country | US
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Telephone | 216-941-0233
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Fax | 216-941-0235
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Provider Business Mailing Address
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Address Line | 3386 WARREN RD
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City | CLEVELAND
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State | OH
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Zip | 44111-2031
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Country | US
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Telephone | 216-941-0233
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Fax | 216-941-0235
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN PAUL SMIK
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Credential | D.P.M.
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Telephone | 216-941-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 36002511
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License Number State | OH
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