Healthcare Provider Details

I. General information

NPI: 1629248778
Provider Name (Legal Business Name): ANTHONY J. BIANCHI DPM P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3566 CONNIE LN
FORT GRATIOT MI
48059-4103
US

IV. Provider business mailing address

3566 CONNIE LN
FORT GRATIOT MI
48059-4103
US

V. Phone/Fax

Practice location:
  • Phone: 810-824-1376
  • Fax:
Mailing address:
  • Phone: 810-824-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901001442
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001442
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901001442
License Number StateMI

VIII. Authorized Official

Name: DR. ANTHONY J BIANCHI
Title or Position: PRESIDENT
Credential: DPM
Phone: 810-824-1376