Provider Demographics
NPI:1649315789
Name:MY FOOT DOCTOR PLLC
Entity type:Organization
Organization Name:MY FOOT DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-559-9700
Mailing Address - Street 1:106 STUART RD NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4803
Mailing Address - Country:US
Mailing Address - Phone:423-559-9700
Mailing Address - Fax:
Practice Address - Street 1:106 STUART RD NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4803
Practice Address - Country:US
Practice Address - Phone:423-559-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000597213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733372Medicaid
TN4118830OtherBLUE CROSS BLUE SHIELD
TNDF2613OtherRAILROAD MEDICARE
TN5661960001Medicare NSC
TNU89442Medicare UPIN
TN3733372Medicare PIN
GA48SCCVSMedicare PIN