Provider Demographics
NPI:1114140977
Name:PORTAGE FOOT HEALTH, INC.
Entity Type:Organization
Organization Name:PORTAGE FOOT HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-297-7330
Mailing Address - Street 1:444 S MERIDIAN ST
Mailing Address - Street 2:STE 7
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2961
Mailing Address - Country:US
Mailing Address - Phone:330-297-7330
Mailing Address - Fax:330-298-0497
Practice Address - Street 1:444 S MERIDIAN ST
Practice Address - Street 2:STE 7
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2961
Practice Address - Country:US
Practice Address - Phone:330-297-7330
Practice Address - Fax:330-298-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1979213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO9286321Medicare PIN
OH5198080001Medicare NSC