Provider Demographics
NPI:1407988223
Name:KISHA MURRAY DREAD DPM PC
Entity Type:Organization
Organization Name:KISHA MURRAY DREAD DPM PC
Other - Org Name:FAMILY FOOTCARE OF LINCOLN PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY-DREAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-942-6500
Mailing Address - Street 1:PO BOX 20848
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-0848
Mailing Address - Country:US
Mailing Address - Phone:248-557-6500
Mailing Address - Fax:248-557-2781
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-557-6500
Practice Address - Fax:248-557-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001881213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI134123036Medicaid
MI383484379OtherTAX ID#
MIU72887Medicare UPIN
MI134123036Medicaid
MI5230860001Medicare NSC