Provider Demographics
NPI:1699980276
Name:EXECUTIVE FOOT CENTER INC
Entity type:Organization
Organization Name:EXECUTIVE FOOT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EZRIEL
Authorized Official - Middle Name:ZELIG
Authorized Official - Last Name:SCHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-379-0398
Mailing Address - Street 1:3650 SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1907
Mailing Address - Country:US
Mailing Address - Phone:800-379-0398
Mailing Address - Fax:216-932-9991
Practice Address - Street 1:5520 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1605
Practice Address - Country:US
Practice Address - Phone:800-379-0398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002038213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57116OtherNATIONWIDE
OH220PROFMEDDUMYOtherANTHEM BLUE CROSS & BLUE
OH0005797562OtherAETNA
OH0465974Medicaid
OH0465974Medicaid
OH220PROFMEDDUMYOtherANTHEM BLUE CROSS & BLUE