Provider Demographics
NPI:1407939333
Name:SOLWAY, JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SOLWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2237
Mailing Address - Country:US
Mailing Address - Phone:734-671-2856
Mailing Address - Fax:734-671-2895
Practice Address - Street 1:22505 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2237
Practice Address - Country:US
Practice Address - Phone:734-671-2856
Practice Address - Fax:734-671-2895
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS001142213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3233383Medicaid
MIT34337Medicare UPIN
MI0M18580Medicare ID - Type Unspecified