Provider Demographics
NPI:1124021910
Name:WINTERS, MARK I (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:I
Last Name:WINTERS
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 1:6200 PLEASANT AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4671
Mailing Address - Country:US
Mailing Address - Phone:513-829-9333
Mailing Address - Fax:
Practice Address - Street 1:1100 N ABBE RD
Practice Address - Street 2:STE D
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1667
Practice Address - Country:US
Practice Address - Phone:440-365-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002339213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0614937Medicaid
OHP00267792OtherRAILROAD MEDICARE
OH4165001Medicare PIN