Provider Demographics
NPI:1437237872
Name:FOOTCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:FOOTCARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUTLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-385-2227
Mailing Address - Street 1:15700 STATE ROUTE 170 STE B
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9657
Mailing Address - Country:US
Mailing Address - Phone:330-385-2227
Mailing Address - Fax:330-385-4242
Practice Address - Street 1:15700 STATE ROUTE 170 STE B
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9657
Practice Address - Country:US
Practice Address - Phone:330-385-2227
Practice Address - Fax:330-385-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001819213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0360961Medicaid
OH2541100Medicaid
OHT80449Medicare UPIN
OH0360961Medicaid
OH2541100Medicaid
9337641Medicare PIN