Provider Demographics
NPI:1912383928
Name:DEARBORN PODIATRY CLINIC PLLC
Entity Type:Organization
Organization Name:DEARBORN PODIATRY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-443-7770
Mailing Address - Street 1:7633 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3730
Mailing Address - Country:US
Mailing Address - Phone:313-821-3338
Mailing Address - Fax:313-823-5363
Practice Address - Street 1:7633 E JEFFERSON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-821-3338
Practice Address - Fax:313-823-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty