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General NPI Number Information
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NPI Number | 1194760835
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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 | 06/17/2006
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 8244 METRO PKWY
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-2778
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Country | US
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Telephone | 586-795-4060
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Fax | 586-795-9956
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Provider Business Mailing Address
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Address Line | 2843 KEELEY CT
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City | WATERFORD
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State | MI
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Zip | 48328
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Country | US
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Telephone | 586-795-4060
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN J REPITOR
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Credential | MD
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Telephone | 586-795-4060
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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 | 5901400227
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License Number State | MI
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