Provider Demographics
NPI:1881849347
Name:CHRISTOPHER M. FALLU DPM, PC
Entity Type:Organization
Organization Name:CHRISTOPHER M. FALLU DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FALLU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-842-3388
Mailing Address - Street 1:6795 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1551
Mailing Address - Country:US
Mailing Address - Phone:313-842-3388
Mailing Address - Fax:313-842-3388
Practice Address - Street 1:6795 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1551
Practice Address - Country:US
Practice Address - Phone:313-842-3388
Practice Address - Fax:313-842-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICF001733261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4173486Medicaid
MI58252560OtherBCBSM
MI0M47900Medicare PIN
MI67138Medicare UPIN