Provider Demographics
NPI:1255513131
Name:DOUGLAS A CUTCHER DPM PLC
Entity type:Organization
Organization Name:DOUGLAS A CUTCHER DPM PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-255-7900
Mailing Address - Street 1:26029 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3235
Mailing Address - Country:US
Mailing Address - Phone:313-255-7900
Mailing Address - Fax:313-255-7901
Practice Address - Street 1:26029 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3235
Practice Address - Country:US
Practice Address - Phone:313-255-7900
Practice Address - Fax:313-255-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4216879Medicaid
MI485825602OtherBCBSM
MI540H228370OtherBCBSM DME
MI5825602Medicare PIN
GA480008804Medicare PIN
MI540H228370OtherBCBSM DME