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General NPI Number Information
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NPI Number | 1538285036
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Entity Type | Organization
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Legal Business Name | MICHIGAN ASSOCIATES IN PODIATRIC MEDICINE AND SURGERY PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 3560 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-2337
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Country | US
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Telephone | 248-674-2575
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Fax | 248-674-0577
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Provider Business Mailing Address
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Address Line | 5379 PLEASANT LAKE DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4715
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Country | US
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Telephone | 248-674-2575
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Fax | 248-674-0577
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DINA M JEGLA
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Credential |
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Telephone | 248-674-2575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000581
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License Number State | MI
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