Provider Demographics
NPI:1740736818
Name:PROVIDERCARE LLC
Entity Type:Organization
Organization Name:PROVIDERCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-392-4290
Mailing Address - Street 1:23250 CHAGRIN BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5417
Mailing Address - Country:US
Mailing Address - Phone:216-402-0027
Mailing Address - Fax:330-574-1050
Practice Address - Street 1:23250 CHAGRIN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5417
Practice Address - Country:US
Practice Address - Phone:216-402-0027
Practice Address - Fax:330-574-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347002808C208600000X
OH36003471213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty