1063411445 NPI number — DR. LAWRENCE STEVEN OSHER D.P.M.

Table of content: DR. LAWRENCE STEVEN OSHER D.P.M. (NPI 1063411445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063411445 NPI number — DR. LAWRENCE STEVEN OSHER D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSHER
Provider First Name:
LAWRENCE
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063411445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2171 CEDARVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-382-0282
Provider Business Mailing Address Fax Number:
216-691-1640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4415 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-231-5612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2117 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH5179 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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