Provider Demographics
NPI:1952531980
Name:MIDWEST FOOTCARE, INC
Entity Type:Organization
Organization Name:MIDWEST FOOTCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:VICHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-642-9936
Mailing Address - Street 1:245 STOCKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1563
Mailing Address - Country:US
Mailing Address - Phone:937-642-9936
Mailing Address - Fax:937-642-5537
Practice Address - Street 1:875 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2601
Practice Address - Country:US
Practice Address - Phone:419-675-3668
Practice Address - Fax:419-675-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1774-V213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2457934Medicaid
5081210003Medicare NSC