MEDICARE: STERLING HEIGHTS UTICA PODIATRISTS 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	213ES0103X	Foot & Ankle Surgery Podiatrist	5901000675	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4885053950	OTHER	MI	BCBS OF MICHIGAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962602565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERLING HEIGHTS UTICA PODIATRISTS PC

Provider Business Mailing Address
First Line	:	8061 21 MILE RD
Second Line	:	SUITE 1&2
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4311
Country	:	US
Telephone Number	:	586-254-2420
Fax Number	:	586-254-2447

Provider Business Practice Location Address
First Line	:	8061 21 MILE RD
Second Line	:	SUITE 1&2
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4311
Country	:	US
Telephone Number	:	586-254-2420
Fax Number	:	586-254-2447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL HOWARD KENT
Credential	:	D.P.M.
Telephone Number	:	586-254-2420

Provider Enumeration Date	:	07/21/2007
Last Update Date	:	09/06/2007

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Directions to “STERLING HEIGHTS UTICA PODIATRISTS PC ” Practice Location

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