Healthcare Provider Details

I. General information

NPI: 1891914636
Provider Name (Legal Business Name): WARREN PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E 13 MILE RD
WARREN MI
48092-3795
US

IV. Provider business mailing address

3701 E 13 MILE RD
WARREN MI
48092-3795
US

V. Phone/Fax

Practice location:
  • Phone: 586-979-1060
  • Fax: 586-979-1714
Mailing address:
  • Phone: 586-979-1060
  • Fax: 586-979-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000850
License Number StateMI

VIII. Authorized Official

Name: ANN M. SPRIET
Title or Position: DPM
Credential:
Phone: 586-979-1060