Provider Demographics
NPI:1861836447
Name:REZNICK WOLF & ASSOCIATES P C
Entity Type:Organization
Organization Name:REZNICK WOLF & ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:REZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-475-1200
Mailing Address - Street 1:1200 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1423
Mailing Address - Country:US
Mailing Address - Phone:734-475-1200
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1423
Practice Address - Country:US
Practice Address - Phone:734-475-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001835213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH16200Medicare UPIN
MIU71058Medicare UPIN
MIU23425Medicare UPIN