Provider Demographics
NPI:1609024918
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:
Authorized Official - Last Name:MARKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-626-5744
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:586-879-5025
Mailing Address - Fax:253-679-5744
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:586-879-5025
Practice Address - Fax:253-679-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM000608332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI875102774Medicaid