Healthcare Provider Details

I. General information

NPI: 1699887083
Provider Name (Legal Business Name): JOHN THROCKMORTON, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 E JOLLY RD
LANSING MI
48910-8547
US

IV. Provider business mailing address

3390 E JOLLY RD
LANSING MI
48910-8547
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-8673
  • Fax: 517-882-3935
Mailing address:
  • Phone: 517-882-8673
  • Fax: 517-882-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000906
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN THROCKMORTON
Title or Position: OWNER
Credential: DPM
Phone: 517-882-8673