Healthcare Provider Details

I. General information

NPI: 1255677761
Provider Name (Legal Business Name): NEWBURGH HEIGHTS PODIATRIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37382 GLENWOOD RD
WESTLAND MI
48186-5447
US

IV. Provider business mailing address

37382 GLENWOOD RD
WESTLAND MI
48186-5447
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-4300
  • Fax: 734-728-4315
Mailing address:
  • Phone: 734-728-4300
  • Fax: 734-728-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000950
License Number StateMI

VIII. Authorized Official

Name: DARYL HOWELL
Title or Position: PRESIDENT
Credential: DPM
Phone: 734-728-4300