Organization
DR. MARK S. MASSIE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S MASSIE DPM (PODIATRIST)
(216) 221-2445
Entity
Organization
Contact information
Practice address
15644 MADISON AVE, LAKEWOOD, OH 44107-5622
(216) 221-2445
(216) 221-5891
Mailing address
PO BOX 40450, BAY VILLAGE, OH 44140-0450
(440) 871-4700
(440) 871-4702
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
3074
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2876351
—
OH
01
—
DE5695
MEDICARE RAILROAD GROUP PIN NUMBER
OH
Enumeration date
11/05/2007
Last updated
08/27/2009
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