Provider Demographics
NPI:1457629800
Name:MAR-LOU SHOES, INC
Entity Type:Organization
Organization Name:MAR-LOU SHOES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-461-6744
Mailing Address - Street 1:5471 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2923
Mailing Address - Country:US
Mailing Address - Phone:440-461-6744
Mailing Address - Fax:440-461-2668
Practice Address - Street 1:5471 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2923
Practice Address - Country:US
Practice Address - Phone:440-461-6744
Practice Address - Fax:440-461-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies