Provider Demographics
NPI:1003935248
Name:ANGELA RENSHAW, DPM, PLLC
Entity Type:Organization
Organization Name:ANGELA RENSHAW, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSTROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-625-2744
Mailing Address - Street 1:3001 PLYMOUTH RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-994-3668
Mailing Address - Fax:734-994-4088
Practice Address - Street 1:3001 PLYMOUTH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-994-3668
Practice Address - Fax:734-994-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001994213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0994547OtherHEALTH PLUS OF MICHIGAN
MI4409614Medicaid
MI4858112380OtherBLUE CROSS
MI4858112380OtherBLUE CARE NETWORK
MI4858112380OtherMEDICARE ADVANTAGE
MI4858112380OtherBLUE CARE NETWORK
MI4858112380OtherBLUE CROSS
MI=========OtherCOFINITY