Madison Lee Podiatry Inc

Primary specialty

PodiatristTaxonomy code 213E00000X

License

2576 Issued in OH

Legal business name

MADISON LEE PODIATRY INC

Practice address

3691 Lee Rd
Suite 102
Shaker Heights, OH 44120-5145

Phone

(216) 491-9902

Fax

(216) 491-8151

NPI assigned

May 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Thomas Portnow, DPMNPI 1962465708

Title

President

Phone

(216) 491-9902

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Thomas Portnow, DPM

  • Podiatrist
  • Shaker Heights, OH
  • NPI 1962465708
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277078400000",
    "number": "1912955162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3691 LEE RD",
            "address_2": "SUITE 102",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441205145",
            "telephone_number": "216-491-9902",
            "fax_number": "216-491-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3691 LEE RD",
            "address_2": "SUITE 102",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441205145",
            "telephone_number": "216-491-9902",
            "fax_number": "216-491-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON LEE PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2010-06-21",
        "status": "A",
        "authorized_official_last_name": "PORTNOW",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-491-9902",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "2576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2245814",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lydia Lutz, MS, CCC-SLP
• Latoya Lykes
• Deontay Lynch
• Joclyn Cherokee Lyons, LPN
• Leigh Bergin Maddy, LSW
• Ashley Majernick
• Michelle Lynn Majka, LISW-S
• Jessica Dawn Majoy, LSW
• David Mandapat
• Evonne Manning

• Podiatrist in Shaker Heights, OH
• Providers in Shaker Heights, OH by specialty
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.