Provider Demographics
NPI:1134212889
Name:BIRCOLL, HERBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:BIRCOLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 E. JEFFERSON
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214
Mailing Address - Country:US
Mailing Address - Phone:313-821-3338
Mailing Address - Fax:313-823-5363
Practice Address - Street 1:7633 E. JEFFERSON
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:313-821-3338
Practice Address - Fax:313-823-5363
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHB000447213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4847804Medicaid
MI0P26350Medicare ID - Type Unspecified
MI4847804Medicaid