MEDICARE: DR. MICHELLE RENEE JUPIN D.P.M.

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	213E00000X	Podiatrist	5901002054	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38-2469733	OTHER	MI	TAX ID FOR PRIMARY LOCATI
2	4856310140	OTHER	MI	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659378552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE RENEE JUPIN D.P.M.

Provider Business Mailing Address
First Line	:	641 W 9 MILE RD
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1779
Country	:	US
Telephone Number	:	248-548-7363
Fax Number	:	248-548-5304

Provider Business Practice Location Address
First Line	:	641 W 9 MILE RD
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1779
Country	:	US
Telephone Number	:	248-548-7363
Fax Number	:	248-548-5304

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/15/2008

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Directions to “ DR. MICHELLE RENEE JUPIN D.P.M.” Practice Location

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