Provider Demographics
NPI:1497785919
Name:ROSENFELD, SHAY N (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:N
Last Name:ROSENFELD
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 1:5905 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2990
Mailing Address - Country:US
Mailing Address - Phone:248-625-3100
Mailing Address - Fax:248-625-1855
Practice Address - Street 1:5905 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2990
Practice Address - Country:US
Practice Address - Phone:248-625-3100
Practice Address - Fax:248-625-1855
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10084213E00000X
MI5901001084213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI134228477Medicaid
MI4856350840OtherBCBSM
OM81950Medicare ID - Type Unspecified
MI4120340001Medicare NSC
MI134228477Medicaid