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General NPI Number Information
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NPI Number | 1194906479
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Entity Type | Organization
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Legal Business Name | AFFILIATED PODIATRIST, P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 35519 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1682
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Country | US
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Telephone | 734-721-0561
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Fax | 734-721-7583
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Provider Business Mailing Address
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Address Line | 35519 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1682
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Country | US
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Telephone | 734-721-0561
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Fax | 734-721-7583
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Authorized Official
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Title or Position | PODIATRIST
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Name | ARTHUR BRUCE KELLERT
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Credential | D.P.M.
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Telephone | 734-721-0561
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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 | AK000685
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License Number State | MI
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