Provider Demographics
NPI:1780771949
Name:LARRY N. MAGID, DPM PC
Entity type:Organization
Organization Name:LARRY N. MAGID, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-471-6593
Mailing Address - Street 1:27609 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1833
Mailing Address - Country:US
Mailing Address - Phone:586-274-7070
Mailing Address - Fax:586-274-9481
Practice Address - Street 1:27609 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1833
Practice Address - Country:US
Practice Address - Phone:586-294-7070
Practice Address - Fax:586-294-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480E014040OtherBCBSM
MI131092965Medicaid
MI131092965Medicaid
MI0P44750Medicare PIN
MIU67916Medicare UPIN
MI4293720001Medicare NSC
MI131092965Medicaid
MIT34398Medicare UPIN