Provider Demographics
NPI:1679510937
Name:NSIMA USEN DPM, MPH, PC
Entity Type:Organization
Organization Name:NSIMA USEN DPM, MPH, PC
Other - Org Name:FAMILY FOOT AND ANKLE SURGEON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NSIMA
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:USEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MPH
Authorized Official - Phone:313-610-0872
Mailing Address - Street 1:20903 GREENFIELD ROAD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:313-610-0872
Mailing Address - Fax:
Practice Address - Street 1:20903 GREENFIELD ROAD
Practice Address - Street 2:SUITE 503
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:313-610-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002130213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4820453Medicaid
MIV06080Medicare UPIN
MI0P21200Medicare ID - Type Unspecified