Provider Demographics
NPI:1770594467
Name:SCHILLER, JOAN ELLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ELLEN
Last Name:SCHILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18599 LAKE SHORE BLVD
Mailing Address - Street 2:SIUTE 600
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1093
Mailing Address - Country:US
Mailing Address - Phone:216-383-6090
Mailing Address - Fax:216-383-5371
Practice Address - Street 1:18599 LAKE SHORE BLVD
Practice Address - Street 2:SIUTE 300
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1093
Practice Address - Country:US
Practice Address - Phone:216-383-6090
Practice Address - Fax:216-383-5371
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002525S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341768928OtherFEDERAL TAX ID
OH36002525SOtherOHIO PODIATRY LICENCE
OH425384190OtherDME
4252980014OtherDME
OHE0627666OtherPIN
OHE0627666OtherPIN