Healthcare Provider Details

I. General information

NPI: 1740203785
Provider Name (Legal Business Name): DENNIS EDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30335 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334
US

IV. Provider business mailing address

24300 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-1616
  • Fax: 248-476-6683
Mailing address:
  • Phone: 248-476-1616
  • Fax: 248-476-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDE000786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: