| Doctor Name: | DR. LAURENCE W SPIVACK |
| NPI Number: | 1043215817 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | OH001535 |
| Business Practice Address: | 9485 Mentor Ave Ste 200 Mentor, OH - 440608723 |
| Business Phone Number: | 4402055878 |
| Business Fax Number: | |
| Mailing Address: | 35010 Chardon Rd 101a, WILLOUGHBY HILLS |
| State: | OH |
| Postal Code: | 440949011 |
| Phone Number: | 4409533668 |
| Fax Number: | 4409533556 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | OH001535 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |