Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36003664 | OH |
Y | 222Z00000X | Podiatrist | 36003664 | OH |
N | 213ES0103X | Foot & Ankle Surgery | 36003664 | OH |
N | 213ES0131X | Foot Surgery | 36003664 | OH |
NPI | 1164749859 |
---|---|
Provider Name | Dr. Jeffrey C Lupica |
First Address | Mentor, OH 44060-8713 |
Second Address | Mentor, OH 44060-8713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 15/06/2021 |