PORTAGE PODIATRY PC NPI 1295996502

NPI Information

NPI: 1295996502
Provider Name: PORTAGE PODIATRY PC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
1508 W CENTRE AVE
PORTAGE, MI
ZIP 49024
Phone: (269) 327-4447
Get Directions

PORTAGE PODIATRY PC is a foot and ankle surgery podiatrist in Portage, MI. PORTAGE PODIATRY PC NPI is 1295996502. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1508 W CENTRE AVE
PORTAGE, MI
ZIP 49024-356
Phone: (269) 327-4447
Fax: (269) 327-3120

The provider's authorized official is David A Vanderbie .
The authorized official title is Physican and has the following contact phone number (269) 327-4447.

The enumeration date for this NPI number is 6/19/2008 and was last updated on 6/19/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	5901001113	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	T33989	MEDICARE UPIN	MICHIGAN
2	1689800	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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