Provider Demographics
NPI:1295727378
Name:PONT, NELSON JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:JOSEPH
Last Name:PONT
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 1:8623 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1489
Mailing Address - Country:US
Mailing Address - Phone:313-563-3750
Mailing Address - Fax:313-563-4434
Practice Address - Street 1:8623 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1489
Practice Address - Country:US
Practice Address - Phone:313-563-3750
Practice Address - Fax:313-563-4434
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI000453213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4816170001OtherDMERC
MI8825378OtherBLUECROSS BLUESHIELD
MI8825378Medicare PIN
MI8825378OtherBLUECROSS BLUESHIELD