MEDICARE: NOMAD PODIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901002254	MI

General Provider Information

NPI Number	:	1609379395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOMAD PODIATRY PLLC

Provider Business Mailing Address
First Line	:	28230 S POINTE LN
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48051-2347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28230 S POINTE LN
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48051-2347
Country	:	US
Telephone Number	:	313-600-6328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN PALAJAC
Credential	:	DPM
Telephone Number	:	313-600-6328

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	03/09/2018

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