is a Foot Surgery in Commerce Twp, Michigan. practices all healthcare services and medical treatments related to Foot Surgery. The NPI Number for is 1871545020. The last update date is .
's current location address is 2559 Union Lake Rd, Commerce Twp, Michigan. You can contact this provider via phone number 2482453392 and fax number 2483638652. The mailing address for is 2559 Union Lake Rd, Commerce Twp, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2559 Union Lake Rd, Commerce Twp, Michigan |
| Phone Number | 2482453392 |
| Fax Number | 2483638652 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1871545020 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2559 Union Lake Rd |
|---|---|
| City | Commerce Twp |
| State | Michigan (MI) |
| Post Code | 483823555 |
| Phone Number | 2482453392 |
| Fax Number | 2483638652 |
Provider's Primary Taxonomy Detail
| Speciality | Foot Surgery |
|---|---|
| Taxonomy | 213Es0131X |
| Licence No | 5901001059 |
|
Definition: A doctor of podiatric medicine who specializes in performing foot and ankle surgeries. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| O-EO-2656-O | MI | BLUE CROSS SUPPLIER PIN | |
| 0D41146 | MI | BLUE CROSS | |
| OEO3185 | MI | BLUE CROSS | |
| 103578 | MI | -- | |
| OEO2782 | MI | BLUE CROSS | |
| 5501440 | MI | BLUE CROSS | |
| OH71150 | MI | BLUE CROSS | |
| 2121060 | MI | -- | |
| 2594961 | MI | -- |
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