Provider Demographics
NPI:1417159237
Name:ADULT AND CHILD PODIATRIC CARE P.C.
Entity Type:Organization
Organization Name:ADULT AND CHILD PODIATRIC CARE P.C.
Other - Org Name:STEPHEN D. PITZER D.P.M.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:PITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-263-4524
Mailing Address - Street 1:43171 DALCOMA DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6307
Mailing Address - Country:US
Mailing Address - Phone:586-263-4524
Mailing Address - Fax:586-263-4290
Practice Address - Street 1:43171 DALCOMA DR
Practice Address - Street 2:SUITE #5
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6307
Practice Address - Country:US
Practice Address - Phone:586-263-4524
Practice Address - Fax:586-263-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000748213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1350756Medicaid
MI0E06138Medicare ID - Type UnspecifiedMEDICARE #
MI1350756Medicaid
MIT34405Medicare UPIN