Provider Demographics
NPI:1053463117
Name:ALFERINK, RAYMOND RANDALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:RANDALL
Last Name:ALFERINK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 W 220TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3340
Mailing Address - Country:US
Mailing Address - Phone:440-734-2228
Mailing Address - Fax:440-734-1793
Practice Address - Street 1:4492 W 220TH ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3340
Practice Address - Country:US
Practice Address - Phone:440-734-2228
Practice Address - Fax:440-734-1793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1686213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487727Medicaid
OHT95755Medicare UPIN
OHAL0511195Medicare ID - Type UnspecifiedFAIRVIEW PARK OFFICE