Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36002808 | OH |
Y | 222Z00000X | Podiatrist | 36002808 | OH |
NPI | 1073541231 |
---|---|
Provider Name | Dr. Thomas E Emmert |
First Address | South Euclid, OH 44121-4007 |
Second Address | Lakewood, OH 44107-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 15/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0924852 | (05) | OH |
U42617 | (02) | OH |