Anthony J. Bianchi DPM P.C.
Organization Active NPI Primary Podiatric Medicine Podiatrist · Fort Gratiot, MI
NPI 1629248778 · NPPES record last updated Sep 21, 2022
Key facts
- NPI
- 1629248778
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Podiatric Medicine Podiatrist 213EP1101X
- License
- 5901001442 (MI)
- Legal business name
- ANTHONY J. BIANCHI DPM P.C.
- Practice address
- 3566 Connie LN
Fort Gratiot, MI 48059-4103 - Phone
- (810) 824-1376
- NPI assigned
- Mar 5, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Anthony J Bianchi, DPM
- Title
- President
- Phone
- (810) 824-1376
Practitioners 1
-
Anthony J. Bianchi, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120516000675 | MI | Part B Supplier - Clinic/Group Practice | 3274653142 |
Receives reassigned benefits from 1 practitioner Practice locations: Fort Gratiot, MI |
National Provider Directory
Locations
1209 10th St
Ste B
Port Huron, MI 48060
Phone (810) 985-3346
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist |
213EP1101X | 5901001442 | MI | Yes |
| Foot Surgery Podiatrist |
213ES0131X | 5901001442 | MI | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5901001442 | MI |
Addresses
Primary practice location
3566 Connie LN
Fort Gratiot, MI 48059-4103
Mailing address
3566 Connie LN
Fort Gratiot, MI 48059-4103
Phone (810) 824-1376
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2886017 | Medicaid | MI |
Other providers in Fort Gratiot, MI
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All providers in Fort Gratiot, MI · Primary Podiatric Medicine Podiatrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.