Provider Demographics
NPI:1962465708
Name:PORTNOW, ROBERT THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:PORTNOW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 LEE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5145
Mailing Address - Country:US
Mailing Address - Phone:216-491-9902
Mailing Address - Fax:216-491-8151
Practice Address - Street 1:3691 LEE RD
Practice Address - Street 2:STE 102
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5145
Practice Address - Country:US
Practice Address - Phone:216-491-9902
Practice Address - Fax:216-491-8151
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2576213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0752707Medicaid
OH480017232OtherRAILROAD MEDICARE
OH0752707Medicaid
OH0779003Medicare PIN
OHT96121Medicare UPIN