Healthcare Provider Details

I. General information

NPI: 1780683896
Provider Name (Legal Business Name): DIGITAL FOOT LAB USA , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 KELLY RD
EASTPOINTE MI
48021-3126
US

IV. Provider business mailing address

1740 W BIG BEAVER RD SUITE 102
TROY MI
48084-3507
US

V. Phone/Fax

Practice location:
  • Phone: 586-200-5870
  • Fax:
Mailing address:
  • Phone: 248-885-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. SHASHIKANT NAGLE
Title or Position: PRESIDENT
Credential: C.P.
Phone: 586-200-5870