Provider Demographics
NPI:1821109836
Name:NORTHWEST PODIATRY PC
Entity Type:Organization
Organization Name:NORTHWEST PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-626-7180
Mailing Address - Street 1:5755 W MAPLE RD
Mailing Address - Street 2:STE 115
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-626-7180
Mailing Address - Fax:248-626-7175
Practice Address - Street 1:5755 W MAPLE RD
Practice Address - Street 2:STE 115
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-626-7180
Practice Address - Fax:248-626-7175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAS400226OtherLICENSE
MIHR001598OtherLICENSE
MI480F371150OtherBLUE CROSS BLUE SHIELD
MILH000829OtherLICENSE
0828050001Medicare NSC
MILH000829OtherLICENSE