Provider Demographics
NPI:1235185414
Name:MOSS, DAVID M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:MOSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27501 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2253
Mailing Address - Country:US
Mailing Address - Phone:734-427-7111
Mailing Address - Fax:734-427-1377
Practice Address - Street 1:27501 WARREN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2253
Practice Address - Country:US
Practice Address - Phone:734-427-7111
Practice Address - Fax:734-427-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
300294762OtherPPOM
480002353OtherTHE TRAVELERS RRM
MI5825121OtherBCBSM
200000000910OtherFIDELIS SECURE CARE
5188247OtherAETNA
T97184Medicare UPIN
MIP54500001Medicare PIN