Provider Demographics
NPI:1538135835
Name:ISMAIL, BILAL E (DPM)
Entity Type:Individual
Prefix:DR
First Name:BILAL
Middle Name:E
Last Name:ISMAIL
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 1:5525 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3253
Mailing Address - Country:US
Mailing Address - Phone:313-846-9717
Mailing Address - Fax:
Practice Address - Street 1:5525 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3253
Practice Address - Country:US
Practice Address - Phone:313-846-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002122213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858213650OtherBLUE CROSS BLUE SHIELD
MI4849095Medicaid
MI4849095Medicaid
MIV08252Medicare UPIN
MI5741820001Medicare NSC
MI4858213650OtherBLUE CROSS BLUE SHIELD