Provider Demographics
NPI:1083801385
Name:7STINES PODIATRY CENTER,PC
Entity Type:Organization
Organization Name:7STINES PODIATRY CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:M
Authorized Official - Last Name:STINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-323-8333
Mailing Address - Street 1:701 SNOW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4087
Mailing Address - Country:US
Mailing Address - Phone:517-323-8333
Mailing Address - Fax:517-323-8333
Practice Address - Street 1:701 SNOW RD
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4087
Practice Address - Country:US
Practice Address - Phone:517-323-8333
Practice Address - Fax:517-323-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901-001340213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1909888Medicaid
MI5235001Medicare PIN
MI1909888Medicaid