MEDICARE: DR. ROBERT THOMAS PORTNOW 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	2576	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480017232	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	:	1962465708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THOMAS PORTNOW DPM

Provider Business Mailing Address
First Line	:	3691 LEE RD
Second Line	:	STE 102
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5145
Country	:	US
Telephone Number	:	216-491-9902
Fax Number	:	216-491-8151

Provider Business Practice Location Address
First Line	:	3691 LEE RD
Second Line	:	STE 102
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5145
Country	:	US
Telephone Number	:	216-491-9902
Fax Number	:	216-491-8151

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	10/25/2007

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Directions to “ DR. ROBERT THOMAS PORTNOW DPM” Practice Location

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