Provider Demographics
NPI:1649395237
Name:MENDELSOHN, ERIC STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STEVEN
Last Name:MENDELSOHN
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 1:26106 GREENFIELD RD STE A
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1063
Mailing Address - Country:US
Mailing Address - Phone:248-569-1395
Mailing Address - Fax:248-569-1330
Practice Address - Street 1:26106 GREENFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1063
Practice Address - Country:US
Practice Address - Phone:248-569-1395
Practice Address - Fax:248-569-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEM000833332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI131388833Medicaid
MIT34223Medicare UPIN
MI131388833Medicaid
MI5752160001Medicare NSC