Provider Demographics
NPI:1356328538
Name:MENDESZOON, MARK J (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MENDESZOON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-713-1779
Mailing Address - Fax:513-854-9921
Practice Address - Street 1:150 7TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2909
Practice Address - Country:US
Practice Address - Phone:440-285-4999
Practice Address - Fax:402-855-8704
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH36.002895213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5392066OtherAETNA
OH139660OtherANTHEM
OH0180094Medicaid
OH480023547OtherMEDICARE RAIL ROAD
OH0132396Medicaid
OHU56410Medicare UPIN