Healthcare Provider Details

I. General information

NPI: 1518087204
Provider Name (Legal Business Name): VALERIE BASKERVILLE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 W BIG BEAVER RD SUITE 137
TROY MI
48084-2809
US

IV. Provider business mailing address

21650 W 11 MILE RD STE 202
SOUTHFIELD MI
48076-3777
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-5200
  • Fax: 248-712-4214
Mailing address:
  • Phone: 248-792-5200
  • Fax: 248-712-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5901001685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: