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General NPI Number Information
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NPI Number | 1588770358
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Entity Type | Organization
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Legal Business Name | ELITE PODIATRY PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 32910 W 13 MILE RD SUITE C300
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1980
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Country | US
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Telephone | 248-996-1020
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Fax | 248-996-1023
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Provider Business Mailing Address
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Address Line | 32910 W 13 MILE RD SUITE C300
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1980
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Country | US
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Telephone | 248-996-1020
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Fax | 248-996-1023
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | ALEXSEY KHEYNSON
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Credential | DPM
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Telephone | 248-996-1020
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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 |
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License Number State |
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