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General NPI Number Information
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NPI Number | 1003128778
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Entity Type | Organization
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Legal Business Name | PODCARE PC
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 3592 CENTER AVE
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City | ESSEXVILLE
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State | MI
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Zip | 48732-1760
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Provider Business Mailing Address
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Address Line | 3061 CHRISTY WAY
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City | SAGINAW
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State | MI
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Zip | 48603-2267
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN REPITOR
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Credential | DPM
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Telephone | 989-791-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | RP400227
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License Number State | MI
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