Provider Demographics
NPI:1932297827
Name:PODIATRY PLUS PC
Entity Type:Organization
Organization Name:PODIATRY PLUS PC
Other - Org Name:PODIATRY PLUS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-349-6855
Mailing Address - Street 1:912 CENTENNIAL WAY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8246
Mailing Address - Country:US
Mailing Address - Phone:517-321-3668
Mailing Address - Fax:517-321-1730
Practice Address - Street 1:912 CENTENNIAL WAY
Practice Address - Street 2:SUITE 380
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8246
Practice Address - Country:US
Practice Address - Phone:517-321-9303
Practice Address - Fax:517-321-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM001350213E00000X
MILN001085213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710897Medicaid
MI1743397Medicaid
MI1743397Medicaid
MI4814430001Medicare NSC