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General NPI Number Information
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NPI Number | 1225496417
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Entity Type | Organization
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Legal Business Name | SCOTT M HOMER DPM PC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 27609 LITTLE MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1833
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Country | US
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Telephone | 586-294-7070
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Fax | 586-294-9481
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Provider Business Mailing Address
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Address Line | 615 W 14 MILE RD
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City | CLAWSON
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State | MI
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Zip | 48017-1901
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Country | US
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Telephone | 248-288-8900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT HOMER
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Credential | DPM
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Telephone | 248-288-8900
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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 | 5901002514
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License Number State | MI
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