MEDICARE: UNIVERSAL PRACTICE PARTNERS 007 LLC

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	213E00000X	Podiatrist	36002339	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE0340	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1285822403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL PRACTICE PARTNERS 007 LLC

Provider Business Mailing Address
First Line	:	6200 PLEASANT AVE
Second Line	:	SUITE 3
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4670
Country	:	US
Telephone Number	:	513-829-9333
Fax Number	:	513-858-7827

Provider Business Practice Location Address
First Line	:	3506 SHANNON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1927
Country	:	US
Telephone Number	:	440-365-2502
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DPM
Name	:	MARK I WINTERS
Credential	:	DPM
Telephone Number	:	440-365-2502

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	06/04/2025

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