MEDICARE: MIDWEST FOOTCARE, INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36-00-1774-V	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	:	1952531980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST FOOTCARE, INC

Provider Business Mailing Address
First Line	:	245 STOCKSDALE DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-1563
Country	:	US
Telephone Number	:	937-642-9936
Fax Number	:	937-642-5537

Provider Business Practice Location Address
First Line	:	875 E COLUMBUS ST
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-2601
Country	:	US
Telephone Number	:	419-675-3668
Fax Number	:	419-675-2237

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEWIS M VICHINSKY
Credential	:	D.P.M.
Telephone Number	:	937-642-9936

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	08/12/2009

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Directions to “MIDWEST FOOTCARE, INC ” Practice Location

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