MEDICARE: DR. BRYAN DEWITT CALDWELL DPM

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	36 002681	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CH5179	OTHER	OH	RR MEDICARE GROUP
4	480031311	OTHER	OH	RR MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366448680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN DEWITT CALDWELL DPM

Provider Business Mailing Address
First Line	:	4415 EUCLID AVE STE 110
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3759
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE STE 110
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3759
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/20/2008

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