Provider Demographics
NPI:1104921287
Name:MIDDLEBURG HEIGHTS PODIATRY LTD
Entity type:Organization
Organization Name:MIDDLEBURG HEIGHTS PODIATRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-238-8843
Mailing Address - Street 1:18660 BAGLEY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-243-1473
Mailing Address - Fax:440-243-1476
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-243-1473
Practice Address - Fax:440-243-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2794712Medicaid
OH2794712Medicaid
OHDG9437Medicare PIN
OH5772750001Medicare NSC