Provider Demographics
NPI:1457563926
Name:ERIC S MENDELSOHN DPM PC
Entity Type:Organization
Organization Name:ERIC S MENDELSOHN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-569-1395
Mailing Address - Street 1:21500 NORTHWESTERN HWY
Mailing Address - Street 2:NORTHLAND CENTER, SUITE 636
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5018
Mailing Address - Country:US
Mailing Address - Phone:248-569-1395
Mailing Address - Fax:248-623-1697
Practice Address - Street 1:21500 NORTHWESTERN HWY
Practice Address - Street 2:NORTHLAND CENTER, SUITE 636
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5018
Practice Address - Country:US
Practice Address - Phone:248-569-1395
Practice Address - Fax:248-623-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEM000833213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5752160001Medicare NSC
MIT34223Medicare UPIN
MI0F37161Medicare PIN