Healthcare Provider Details

I. General information

NPI: 1275454928
Provider Name (Legal Business Name): SOLE PURPOSE PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16540 19 MILE RD
CLINTON TOWNSHIP MI
48038-1106
US

IV. Provider business mailing address

42384 BEECHWOOD DR
STERLING HEIGHTS MI
48314-2944
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-8660
  • Fax:
Mailing address:
  • Phone: 248-331-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NADINE KASTAW
Title or Position: PODIATRIST-SELF
Credential:
Phone: 248-331-3237