Provider Demographics
NPI:1881626646
Name:ASEF, ATTA J (DPM)
Entity type:Individual
Prefix:DR
First Name:ATTA
Middle Name:J
Last Name:ASEF
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 1:35010 CHARDON ROAD
Mailing Address - Street 2:SUITE #101A
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9011
Mailing Address - Country:US
Mailing Address - Phone:440-953-3668
Mailing Address - Fax:440-953-3556
Practice Address - Street 1:35010 CHARDON ROAD
Practice Address - Street 2:SUITE #101A
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9011
Practice Address - Country:US
Practice Address - Phone:440-953-3668
Practice Address - Fax:440-953-3556
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2887A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000122928OtherANTHEMBCBS
OH3025514Medicaid
OH2085023Medicaid
OH000000122928OtherANTHEMBCBS
OH0850357Medicare PIN
OH0850358Medicare PIN
OH2085023Medicaid
OH3025514Medicaid
OH4771320004Medicare NSC