Healthcare Provider Details

I. General information

NPI: 1952822132
Provider Name (Legal Business Name): DAMIAN JOSEPH HILBERT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

1040 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax:
Mailing address:
  • Phone: 608-847-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number5901002697
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002697
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1187-25
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5951000927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: