Provider Demographics
NPI:1558559278
Name:GREAT LAKES PODIATRY CENTER INC
Entity Type:Organization
Organization Name:GREAT LAKES PODIATRY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-282-4355
Mailing Address - Street 1:4642 OBERLIN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3164
Mailing Address - Country:US
Mailing Address - Phone:440-282-4355
Mailing Address - Fax:440-282-4355
Practice Address - Street 1:2217 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2614
Practice Address - Country:US
Practice Address - Phone:440-282-4355
Practice Address - Fax:440-282-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3122213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty