Provider Demographics
NPI:1285822403
Name:UNIVERSAL PRACTICE PARTNERS 007 LLC
Entity Type:Organization
Organization Name:UNIVERSAL PRACTICE PARTNERS 007 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPM
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-365-2502
Mailing Address - Street 1:6200 PLEASANT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4670
Mailing Address - Country:US
Mailing Address - Phone:513-829-9333
Mailing Address - Fax:513-858-7827
Practice Address - Street 1:1100 N ABBE RD
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002339213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE0340OtherRAILROAD MEDICARE
OH2878748Medicaid
OHDE0340OtherRAILROAD MEDICARE