Basic Information
| Provider Information | |||||||||
| NPI: | 1942512710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PODCARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3061 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 SOUTH BLVD E | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483076122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489977900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 07/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | SWARTZ | ||||||||
| AuthorizedOfficialFirstName: | KELLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9897912455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PRO MED BILLING | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | RS400227 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1194760835 | 05 | MI | MEDICAID |