Provider Demographics
NPI:1053574558
Name:BARAK PODIATRY,LLC
Entity type:Organization
Organization Name:BARAK PODIATRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-360-6545
Mailing Address - Street 1:6715 TIPPECANOE RD
Mailing Address - Street 2:SUITE 100, BLDG D
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8180
Mailing Address - Country:US
Mailing Address - Phone:330-286-0462
Mailing Address - Fax:330-286-0436
Practice Address - Street 1:6715 TIPPECANOE RD
Practice Address - Street 2:BUILDING D, SUITE 100
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8180
Practice Address - Country:US
Practice Address - Phone:330-286-0462
Practice Address - Fax:330-286-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003489213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6204490003Medicare NSC