Provider Demographics
NPI:1871706416
Name:MARC SLOMOVITZ, DPM, CORP.
Entity type:Organization
Organization Name:MARC SLOMOVITZ, DPM, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SLOMOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-475-5944
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:STE 355
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-475-5944
Mailing Address - Fax:216-475-5960
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:STE 355
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-475-5944
Practice Address - Fax:216-475-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002542213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741371Medicaid
OH9365891Medicare PIN
OH5880320001Medicare NSC
OHT92694Medicare UPIN