MEDICARE: PREFERRED PODIATRY GROUP PC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	CB3726	OTHER	WI	RAILROAD MEDICARE
7	DU2423	OTHER	KY	RAILROAD MEDICARE
9	CH4840	OTHER	IN	RAILROAD MEDICARE
10	DS6430	OTHER	MO	RAILROAD MEDICARE
12	DR6817	OTHER	TX	RAILROAD MEDICARE
14	DW2909	OTHER	OK	RAILROAD MEDICARE
16	C12116	OTHER	IL	RAILROAD MEDICARE
17	DX1124	OTHER	IA	RAILROAD MEDICARE
20	DW2427	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720037138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED PODIATRY GROUP PC

Provider Business Mailing Address
First Line	:	PO BOX 772294
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-0917
Country	:	US
Telephone Number	:	847-504-5000
Fax Number	:	844-443-0082

Provider Business Practice Location Address
First Line	:	171 SW 6TH AVE
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-2377
Country	:	US
Telephone Number	:	847-504-5000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVIN KESTNER
Credential	:
Telephone Number	:	847-504-5002

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/06/2026

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