MEDICARE: DR. NELSON JOSEPH PONT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	000453	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4816170001	OTHER	MI	DMERC
2	8825378	OTHER	MI	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1295727378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON JOSEPH PONT DPM

Provider Business Mailing Address
First Line	:	8623 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1489
Country	:	US
Telephone Number	:	313-563-3750
Fax Number	:	313-563-4434

Provider Business Practice Location Address
First Line	:	8623 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1489
Country	:	US
Telephone Number	:	313-563-3750
Fax Number	:	313-563-4434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/18/2010

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