Provider Demographics
NPI:1134124498
Name:SCHWARTZ, JOEL D (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:D
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:5373 KILBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3744
Mailing Address - Country:US
Mailing Address - Phone:440-461-0074
Mailing Address - Fax:330-425-0702
Practice Address - Street 1:8984 DARROW RD STE 2
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2186
Practice Address - Country:US
Practice Address - Phone:330-425-4888
Practice Address - Fax:330-425-0702
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1440-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114370Medicaid
OH0114370Medicaid
OHT80316Medicare UPIN