Provider Demographics
NPI:1609868876
Name:MARKLE, CHARLES J (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:MARKLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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:248-626-5858
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:248-626-5858
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI59000608213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5102774Medicaid
MI1059290Medicaid
MI5102774Medicaid
MI05238033301Medicare NSC
MI1059290Medicaid