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General NPI Number Information
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NPI Number | 1336252857
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Entity Type | Organization
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Legal Business Name | PODIATRY EXAMINERS OF MICHIGAN PC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3800 WOODWARD AVENUE SUITE 318
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City | DETROIT
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State | MI
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Zip | 48201-2066
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Country | US
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Telephone | 313-833-3096
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Fax | 313-833-7843
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Provider Business Mailing Address
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Address Line | 3800 WOODWARD AVENUE SUITE 318
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City | DETROIT
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State | MI
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Zip | 48201-2066
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Country | US
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Telephone | 313-833-3096
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Fax | 313-833-7843
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG MARSHALL GASTWIRTH
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Credential | DPM
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Telephone | 313-833-3090
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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 | 0814
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License Number State | MI
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