Provider Demographics
NPI:1730289232
Name:REDMOND, ERIC (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:REDMOND
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 1:29325 GLENARDEN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2737
Mailing Address - Country:US
Mailing Address - Phone:248-489-1887
Mailing Address - Fax:
Practice Address - Street 1:29325 GLENARDEN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2737
Practice Address - Country:US
Practice Address - Phone:248-489-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400155213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5635372OtherBCBSM
MI134247098Medicaid
MI5825526Medicare PIN
MI5635372OtherBCBSM