Provider Demographics
NPI:1891222964
Name:AUSTIN, SAMUEL THADDEUS (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THADDEUS
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD STE 235
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4315
Mailing Address - Country:US
Mailing Address - Phone:248-646-6882
Mailing Address - Fax:248-646-7677
Practice Address - Street 1:31500 TELEGRAPH RD STE 235
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4315
Practice Address - Country:US
Practice Address - Phone:248-646-6882
Practice Address - Fax:248-646-7677
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400369213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty