Provider Demographics
NPI:1184886111
Name:MASKILL, MICHAEL P (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:MASKILL
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 1:7971 MOORSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4075
Mailing Address - Country:US
Mailing Address - Phone:269-323-2094
Mailing Address - Fax:269-323-2095
Practice Address - Street 1:7971 MOORSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4075
Practice Address - Country:US
Practice Address - Phone:269-323-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002313213E00000X, 213ES0103X
MEPOD1063213E00000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332900000XSuppliersNon-Pharmacy Dispensing Site