Provider Demographics
NPI:1508905985
Name:GEORGETOWN PODIATRIC SURGEONS PC
Entity Type:Organization
Organization Name:GEORGETOWN PODIATRIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-977-7200
Mailing Address - Street 1:3058 METROPOLITAN PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3680
Mailing Address - Country:US
Mailing Address - Phone:586-977-7200
Mailing Address - Fax:586-977-7291
Practice Address - Street 1:3058 METROPOLITAN PKWY STE 206
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3680
Practice Address - Country:US
Practice Address - Phone:586-977-7200
Practice Address - Fax:586-977-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000652213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT97294Medicare UPIN
MI8505388Medicare ID - Type Unspecified