Provider Demographics
NPI:1740203785
Name:EDER, DENNIS (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:EDER
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 1:24300 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-476-1616
Mailing Address - Fax:248-476-6683
Practice Address - Street 1:30335 W 13 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-476-1616
Practice Address - Fax:248-476-6683
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDE000786213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480009796OtherMEDICARE RR PIN
MI1275535Medicaid
T34221Medicare UPIN
MIOH27869002Medicare ID - Type Unspecified