Provider Demographics
NPI:1851382972
Name:MAGID, LARRY N (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:N
Last Name:MAGID
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 1:27609 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1833
Mailing Address - Country:US
Mailing Address - Phone:586-294-7070
Mailing Address - Fax:586-294-9481
Practice Address - Street 1:27609 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1833
Practice Address - Country:US
Practice Address - Phone:586-294-7070
Practice Address - Fax:586-294-9481
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILM000741213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480E014040OtherBCBSM
MI1092965 TYPE 13Medicaid
MI1092965 TYPE 13Medicaid
MI480E014040OtherBCBSM
MI4293720001Medicare NSC
MI4293720001Medicare NSC