Organization Name: | PODIATRY HOME HEALTH CARE |
NPI Number: | 1023250248 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARBARA LYNN PETKOVIC (PODIATRIST) |
Mailing Address: | 5683 Pearl Rd Parma |
State: | OH US |
Postal Code: | 441292528 |
Phone Number: | 4408852130 |
Fax Number: | 4408488406 |
NPI Enumeration Date: | 04/02/2009 |
NPI Last Update Date: | 05/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | 36003284 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |