Provider Demographics
NPI:1568452001
Name:SENGSTOCK, JODIE (DPM)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:SENGSTOCK
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 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 1175
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-624-8338
Mailing Address - Fax:248-926-9498
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1175
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-624-8338
Practice Address - Fax:248-926-9498
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001814213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU67188Medicare UPIN