Healthcare Provider Details

I. General information

NPI: 1891725818
Provider Name (Legal Business Name): COMMUNITY PODIATRY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S LINDEN RD STE D
FLINT MI
48532-3442
US

IV. Provider business mailing address

1303 S LINDEN RD STE D
FLINT MI
48532-3442
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-0177
  • Fax: 810-230-8090
Mailing address:
  • Phone: 810-230-0177
  • Fax: 810-230-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002073
License Number StateMI

VIII. Authorized Official

Name: DAVID T TAYLOR
Title or Position: OWNER
Credential: DPM
Phone: 810-230-0177