MEDICARE: LAKEWOOD AMBULATORY FOOT CEN

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	261QP1100X	Podiatric Clinic/Center	36002511	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL1324	OTHER	OH	RAILROAD 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

General Provider Information

NPI Number	:	1942489257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD AMBULATORY FOOT CEN

Provider Business Mailing Address
First Line	:	3386 WARREN RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2031
Country	:	US
Telephone Number	:	216-941-0233
Fax Number	:	216-941-0235

Provider Business Practice Location Address
First Line	:	3386 WARREN ROAD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-0000
Country	:	US
Telephone Number	:	216-941-0233
Fax Number	:	216-941-0235

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN PAUL SMIK
Credential	:	D.P.M.
Telephone Number	:	216-941-0233

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	10/09/2019

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Directions to “LAKEWOOD AMBULATORY FOOT CEN ” Practice Location

Language	Start Address	Practice Location

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