Healthcare Provider Details

I. General information

NPI: 1275715070
Provider Name (Legal Business Name): MALCOLM B PIKE DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N MICHIGAN AVE
SAGINAW MI
48602-4732
US

IV. Provider business mailing address

1300 N MICHIGAN AVE
SAGINAW MI
48602-4732
US

V. Phone/Fax

Practice location:
  • Phone: 989-752-8189
  • Fax: 989-752-8330
Mailing address:
  • Phone: 989-752-8189
  • Fax: 989-752-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000623
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MALCOLM BRUCE PIKE
Title or Position: DOCTOR OF PODIATRY
Credential: DPM
Phone: 989-752-8189