Provider Demographics
NPI:1225496417
Name:SCOTT M HOMER DPM PC
Entity Type:Organization
Organization Name:SCOTT M HOMER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-288-8900
Mailing Address - Street 1:615 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1901
Mailing Address - Country:US
Mailing Address - Phone:248-288-8900
Mailing Address - Fax:
Practice Address - Street 1:27609 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1833
Practice Address - Country:US
Practice Address - Phone:586-294-7070
Practice Address - Fax:586-294-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002514213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225496417Medicaid