Healthcare Provider Details

I. General information

NPI: 1104976679
Provider Name (Legal Business Name): MARK L RILEY DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 PIERCE ST
BIRMINGHAM MI
48009
US

IV. Provider business mailing address

1327 PIERCE ST
BIRMINGHAM MI
48009
US

V. Phone/Fax

Practice location:
  • Phone: 248-355-5353
  • Fax:
Mailing address:
  • Phone: 248-355-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARK L RILEY
Title or Position: PRESIDENT
Credential: DPM
Phone: 248-355-5353