Chantale Esther Bothuell, D.P.M.
Individual provider Active NPI Podiatrist · Keego Harbor, MI
NPI 1457566341 · NPPES record last updated Mar 9, 2017
Key facts
- NPI
- 1457566341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 5901002140 (MI)
- Practice address
- 2424 Fordham St
Keego Harbor, MI 48320-1412 - Phone
- (313) 384-7300
- Fax
- (248) 747-4014
- NPI assigned
- May 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Director Services PC | Current |
Accepting new patients | |
| Excel Footcare | Podiatrist | Current | Accepting new patients |
| Healthland Housecall Services LLC | Past |
Accepting new patients | |
| Lake Mi Mobile Doctors, P.C. | Podiatrist | Past | Accepting new patients |
| Lake Mi Mobile Doctors PC | Podiatrist | Past | Accepting new patients |
Locations
19840 Harper Ave
Harper Woods, MI 48225
Phone (313) 381-9556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 5901002140 | MI | Yes |
Addresses
Primary practice location
2424 Fordham St
Keego Harbor, MI 48320-1412
Mailing address
2424 Fordham St
Keego Harbor, MI 48320-1412
Phone (313) 384-7300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2265017 | Medicaid | MI |
Other providers in Keego Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.