Healthcare Provider Details

I. General information

NPI: 1902108152
Provider Name (Legal Business Name): BC PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2010
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 TEN MILE RD
SOUTH LYON MI
48178-9143
US

IV. Provider business mailing address

13650 TEN MILE RD
SOUTH LYON MI
48178-9143
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-1177
  • Fax:
Mailing address:
  • Phone: 248-486-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901001043
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901002128
License Number StateMI

VIII. Authorized Official

Name: BRIAN BURKARDT DPM
Title or Position: OWNER/PHYSICAN
Credential:
Phone: 734-308-2973