Provider Demographics
NPI:1942295001
Name:RICHMOND FOOT & ANKLE CARE, INC.
Entity Type:Organization
Organization Name:RICHMOND FOOT & ANKLE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUKH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-481-6654
Mailing Address - Street 1:464 RICHMOND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2704
Mailing Address - Country:US
Mailing Address - Phone:216-481-6654
Mailing Address - Fax:216-481-3185
Practice Address - Street 1:464 RICHMOND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2704
Practice Address - Country:US
Practice Address - Phone:216-481-6654
Practice Address - Fax:216-481-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003112213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2787622Medicaid
OH4218210002Medicare NSC
OHU83705Medicare UPIN
OH4218210001Medicare NSC
OHDG6259Medicare PIN
OH9347401Medicare PIN