=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821017930
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRYL FRANCIS KOMPUS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41100 FOX RUN
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-668-8650
-----------------------------------------------------
Fax | 248-668-8651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 EXECUTIVE DR STE 230
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-668-8650
-----------------------------------------------------
Fax | 248-668-8651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | DK001659
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------