Provider Demographics
NPI:1467677468
Name:SPORTS PODIATRY RESOURCE INC
Entity Type:Organization
Organization Name:SPORTS PODIATRY RESOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-277-2662
Mailing Address - Street 1:67 UNION ST STE 310
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:617-277-2662
Mailing Address - Fax:617-734-9733
Practice Address - Street 1:67 UNION ST STE 310
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:617-277-2662
Practice Address - Fax:617-734-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1511213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70618Medicare PIN
MAT58691Medicare UPIN
MA1055630001Medicare NSC