Unknown Individual – Podiatrist, NPI 1710031646

Unknown Individual is a healthcare provider. based in Erie, Pennsylvania. specializing in Podiatrist. They hold a License No. SC001336L (PA). The NPI Number for Unknown Individual is 1710031646

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710031646
Phone
(814) 868-2170
Address
5401 Peach St
Deactivation Date
1 March 2023

Doctor Profile

Medical School Name
KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
Secondary Phone
-
Graduation Year
1968 (58 years ago)
PAC ID
8921086356
Professional Enrollment ID
I20040712000563
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 5401 Peach St

    Erie, PA 165092601

    Phone: (814) 868-2170

    Fax: (814) 868-2108

    Type: Location

  • 5100 Peach St

    Erie, PA 165092482

    Phone: (814) 868-8588

    Fax: (814) 866-0530

    Type: Location

  • 938, Powell Avenue, Lakewood, Millcreek Township, Erie County, Pennsylvania, 16505, United States

    ERIE, PA 165053439

    Phone: (814) 833-8331

    Fax: (814) 833-8338

    Type: Location

  • LECOM Bayfront, 1, Lecom Place, Frontier, Erie, Erie County, Pennsylvania, 16505, United States

    ERIE, PA 165052571

    Phone: (814) 868-2507

    Fax: (814) 868-2522

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 16509)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1710031646.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Podiatrist in this dataset. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Erie, Pennsylvania; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
4 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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DR. MATTHEW ADAM TESTRAKE (DPM)

Foot & Ankle Surgery Podiatrist
9500 EUCLID AVE
NPI: 1609030634