Provider Demographics
NPI:1467825646
Name:PODIATRY HOME CARE PLLC
Entity Type:Organization
Organization Name:PODIATRY HOME CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ELZINGA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-721-1298
Mailing Address - Street 1:4774 GRANDWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1330
Mailing Address - Country:US
Mailing Address - Phone:517-721-1298
Mailing Address - Fax:517-721-1829
Practice Address - Street 1:4774 GRANDWOODS DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1330
Practice Address - Country:US
Practice Address - Phone:517-721-1298
Practice Address - Fax:517-721-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty