Provider Demographics
NPI:1003967894
Name:MICHAEL J KING DPM
Entity Type:Organization
Organization Name:MICHAEL J KING DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-679-5700
Mailing Address - Street 1:222 MILLIKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1623
Mailing Address - Country:US
Mailing Address - Phone:508-679-5700
Mailing Address - Fax:508-679-7759
Practice Address - Street 1:222 MILLIKEN BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1623
Practice Address - Country:US
Practice Address - Phone:508-679-5700
Practice Address - Fax:508-679-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9710311Medicaid
MAY75093Medicare PIN
MA9710311Medicaid
MAY70716Medicare PIN
MALX5217Medicare PIN
MAY70866Medicare PIN
MA000CJ2902Medicare PIN
MA4785500001Medicare NSC
MALX5218Medicare PIN