Healthcare Provider Details

I. General information

NPI: 1780814194
Provider Name (Legal Business Name): RESIDENTIAL PODIATRY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20927 KELLY RD
EASTPOINTE MI
48021-3128
US

IV. Provider business mailing address

20927 KELLY RD
EASTPOINTE MI
48021-3128
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-8801
  • Fax: 586-777-9988
Mailing address:
  • Phone: 586-777-8801
  • Fax: 586-777-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002254
License Number StateMI

VIII. Authorized Official

Name: DR. STEPHEN J PALAJAC
Title or Position: PARTNER/OWNER
Credential: D.P.M.
Phone: 586-777-8801