MEDICARE: DR. MICHAEL WENOWITZ 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	390200000X	Student in an Organized Health Care Education/Training Program		OH
2	213ES0131X	Foot Surgery Podiatrist	36.003927	OH

General Provider Information

NPI Number	:	1417311705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WENOWITZ DPM

Provider Business Mailing Address
First Line	:	27100 CHARDON RD
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-1116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 COOPER FOSTER PARK RD W
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44053-4201
Country	:	US
Telephone Number	:	440-282-1221
Fax Number	:	440-960-0010

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

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	05/19/2019

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