Affiliated Podiatrist, P.C.
Organization Active NPI Podiatrist · Wayne, MI
NPI 1194906479 · NPPES record last updated May 1, 2008
Key facts
- NPI
- 1194906479
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- AK000685 (MI)
- Legal business name
- AFFILIATED PODIATRIST, P.C.
- Practice address
- 35519 E Michigan Ave
Wayne, MI 48184-1682 - Phone
- (734) 721-0561
- Fax
- (734) 721-7583
- NPI assigned
- Nov 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Arthur Bruce Kellert, D.P.M.
- Title
- Podiatrist
- Phone
- (734) 721-0561
National Provider Directory
Locations
35519 E Michigan Ave
Wayne, MI 48184
Phone (734) 721-0561
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | AK000685 | MI | Yes |
Addresses
Primary practice location
35519 E Michigan Ave
Wayne, MI 48184-1682
Mailing address
35519 E Michigan Ave
Wayne, MI 48184-1682
Phone (734) 721-0561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1074377 | Medicaid | MI |
Other providers in Wayne, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.