Healthcare Provider Details

I. General information

NPI: 1821109836
Provider Name (Legal Business Name): NORTHWEST PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 W MAPLE RD STE 115
WEST BLOOMFIELD MI
48322-4415
US

IV. Provider business mailing address

5755 W MAPLE RD STE 115
WEST BLOOMFIELD MI
48322-4415
US

V. Phone/Fax

Practice location:
  • Phone: 248-626-7180
  • Fax: 248-626-7175
Mailing address:
  • Phone: 248-626-7180
  • Fax: 248-626-7175

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 Number
License Number State

VIII. Authorized Official

Name: DR. ALAN SCHRAM
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 248-626-7180