Provider Demographics
NPI:1598881088
Name:CHARLES J MARKLE DPM PC
Entity Type:Organization
Organization Name:CHARLES J MARKLE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-421-1520
Mailing Address - Street 1:4318 SPRINGHILL CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3135
Mailing Address - Country:US
Mailing Address - Phone:248-421-1520
Mailing Address - Fax:
Practice Address - Street 1:4318 SPRINGHILL CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3135
Practice Address - Country:US
Practice Address - Phone:248-421-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000608213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5102774Medicaid
MI5505026OtherBC
MI1059290Medicaid
MI1059290Medicaid
MI=========OtherEIN
MIT91408Medicare UPIN
MI0523830001Medicare NSC