MEDICARE: MIDDLEBURG HEIGHTS PODIATRY LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104921287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLEBURG HEIGHTS PODIATRY LTD

Provider Business Mailing Address
First Line	:	18660 BAGLEY RD
Second Line	:	SUITE 301
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3483
Country	:	US
Telephone Number	:	440-243-1473
Fax Number	:	440-243-1476

Provider Business Practice Location Address
First Line	:	18660 BAGLEY RD
Second Line	:	SUITE 301
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3483
Country	:	US
Telephone Number	:	440-243-1473
Fax Number	:	440-243-1476

Authorized Official
Title or Position	:	ACCESS MANAGER
Name	:	ROBIN BROWN
Credential	:
Telephone Number	:	440-238-8843

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/07/2021

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Directions to “MIDDLEBURG HEIGHTS PODIATRY LTD ” Practice Location

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