Individual
DR. MARK S MASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
15644 MADISON AVE, 106, 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
3600307M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2066204
—
OH
01
—
P00301287
MEDICARE RAILROAD PIN
OH
Enumeration date
05/13/2006
Last updated
07/17/2010
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