Healthcare Provider Details

I. General information

NPI: 1588770358
Provider Name (Legal Business Name): ELITE PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32910 W 13 MILE RD SUITE C300
FARMINGTON HILLS MI
48334-1980
US

IV. Provider business mailing address

32910 W 13 MILE RD SUITE C300
FARMINGTON HILLS MI
48334-1980
US

V. Phone/Fax

Practice location:
  • Phone: 248-996-1020
  • Fax: 248-996-1023
Mailing address:
  • Phone: 248-996-1020
  • Fax: 248-996-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXSEY KHEYNSON
Title or Position: OWNER PRESIDENT
Credential: DPM
Phone: 248-996-1020