Provider Demographics
NPI:1891725818
Name:COMMUNITY PODIATRY GROUP, P.C.
Entity Type:Organization
Organization Name:COMMUNITY PODIATRY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-230-0177
Mailing Address - Street 1:1303 S LINDEN RD STE D
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3442
Mailing Address - Country:US
Mailing Address - Phone:810-230-0177
Mailing Address - Fax:810-230-8090
Practice Address - Street 1:1303 S LINDEN RD STE D
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3442
Practice Address - Country:US
Practice Address - Phone:810-230-0177
Practice Address - Fax:810-230-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002073213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480B56155OtherBLUE CROSS BLUE SHIELD
MIOB56155Medicare UPIN
MI1004870001Medicare NSC