Healthcare Provider Details

I. General information

NPI: 1467491720
Provider Name (Legal Business Name): CHARLES R YOUNG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21111 MIDDLEBELT RD
FARMINGTON HILLS MI
48336-5549
US

IV. Provider business mailing address

21111 MIDDLEBELT RD
FARMINGTON HILLS MI
48336-5549
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-1150
  • Fax: 248-478-1156
Mailing address:
  • Phone: 248-478-1150
  • Fax: 248-478-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberCY000630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: