Provider Demographics
NPI:1245357771
Name:NORTH SHORE PODIATRY INC
Entity type:Organization
Organization Name:NORTH SHORE PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-930-8637
Mailing Address - Street 1:515 MOORE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2366
Mailing Address - Country:US
Mailing Address - Phone:440-930-8637
Mailing Address - Fax:
Practice Address - Street 1:515 MOORE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2366
Practice Address - Country:US
Practice Address - Phone:440-930-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278306Medicaid
OH2853309Medicaid
OHDD8373OtherRAILROAD MEDICARE
OH9345351Medicare PIN
OH5233620001Medicare NSC
OH2853309Medicaid