Healthcare Provider Details

I. General information

NPI: 1790880284
Provider Name (Legal Business Name): AIMEE ANTOINETTE POPOFSKI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE ANTOINETTE BOYETTE DPM

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29433 RYAN RD
WARREN MI
48092-2203
US

IV. Provider business mailing address

9640 COMMERCE RD SUITE 102
COMMERCE TWP MI
48382-4166
US

V. Phone/Fax

Practice location:
  • Phone: 865-574-0500
  • Fax: 586-574-2694
Mailing address:
  • Phone: 248-360-3888
  • Fax: 248-363-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: