Provider Demographics
NPI:1689684870
Name:MICHIGAN PODIATRY INSTITUTE, P.C.
Entity Type:Organization
Organization Name:MICHIGAN PODIATRY INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-541-4311
Mailing Address - Street 1:1026 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3218
Mailing Address - Country:US
Mailing Address - Phone:248-541-4311
Mailing Address - Fax:248-541-9036
Practice Address - Street 1:1026 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3218
Practice Address - Country:US
Practice Address - Phone:248-541-4311
Practice Address - Fax:248-541-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000484213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0812360002Medicare NSC