Provider Demographics
NPI:1063401727
Name:LUBELL, JEFFREY D (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:LUBELL
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 1:628 E 222ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2032
Mailing Address - Country:US
Mailing Address - Phone:216-731-8052
Mailing Address - Fax:216-731-1855
Practice Address - Street 1:628 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2032
Practice Address - Country:US
Practice Address - Phone:216-731-8052
Practice Address - Fax:216-731-1855
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2220-L213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0592943Medicaid
OHLU0569953Medicare PIN
OHLU0569951Medicare PIN
OH1205010634Medicare NSC
OHT80745Medicare UPIN
OHLU0569954Medicare PIN