Healthcare Provider Details

I. General information

NPI: 1588603518
Provider Name (Legal Business Name): MICHAEL PATRICK FLATLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 ROUTE 44
SWEDESBORO NJ
08085-4426
US

IV. Provider business mailing address

356 ROUTE 44
SWEDESBORO NJ
08085-4426
US

V. Phone/Fax

Practice location:
  • Phone: 856-241-1872
  • Fax: 856-241-1872
Mailing address:
  • Phone: 856-241-1872
  • Fax: 856-241-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00268300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: