Healthcare Provider Details

I. General information

NPI: 1144431669
Provider Name (Legal Business Name): HPFC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18460 REVERE ST
DETROIT MI
48234-1726
US

IV. Provider business mailing address

18460 REVERE ST
DETROIT MI
48234-1726
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-4400
  • Fax: 313-865-4400
Mailing address:
  • Phone: 313-865-4400
  • Fax: 313-865-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001377
License Number StateMI

VIII. Authorized Official

Name: DR. RONALD EUGENE WILSON
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 313-865-4400