Provider Demographics
NPI:1518087204
Name:BASKERVILLE, VALERIE (DPM)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21650 W 11 MILE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3777
Mailing Address - Country:US
Mailing Address - Phone:248-792-5200
Mailing Address - Fax:248-712-4214
Practice Address - Street 1:3310 W BIG BEAVER RD
Practice Address - Street 2:SUITE 137
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2809
Practice Address - Country:US
Practice Address - Phone:248-792-5200
Practice Address - Fax:248-712-4214
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001685213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H21400OtherBCBSM
MI3217423Medicaid
MI3217423Medicaid
MIU59385Medicare UPIN