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General NPI Number Information
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NPI Number | 1073849428
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Entity Type | Organization
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Legal Business Name | MIDLAND PODIATRY ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 4911 HEDGEWOOD DR
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City | MIDLAND
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State | MI
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Zip | 48640-1930
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Country | US
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Telephone | 989-631-8200
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Fax | 989-631-5901
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Provider Business Mailing Address
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Address Line | 4911 HEDGEWOOD DR
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City | MIDLAND
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State | MI
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Zip | 48640-1930
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Country | US
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Telephone | 989-631-8200
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Fax | 989-631-5901
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TAMMY L BAILER
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Credential |
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Telephone | 989-631-8200
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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 | DS001126
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | JS001702
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | TL001607
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License Number State | MI
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