1306942842 NPI number — BC PODIATRY PLLC

Table of content: (NPI 1306942842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306942842 NPI number — BC PODIATRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BC PODIATRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENTLE FOOT & ANKLE CARE LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306942842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31017 JOHN R RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48071-1907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-585-1177
Provider Business Mailing Address Fax Number:
248-585-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31017 JOHN R RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48071-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-585-1177
Provider Business Practice Location Address Fax Number:
248-585-0083
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DPM
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
BURKARDT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-308-2973

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480F337000 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480F337000 . This is a "BLUE CROSS FEP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI1200 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CN3339 . This is a "RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P41010 . This is a "MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P41010 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P41010 . This is a "MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4480020001 . This is a "MEDICARE DMERC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480F337000 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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