1588770358 NPI number — ELITE PODIATRY PC

Table of content: (NPI 1588770358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588770358 NPI number — ELITE PODIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE PODIATRY PC
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:
Provider Other Organization Name Type Code:
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:
1588770358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32910 W 13 MILE RD
Provider Second Line Business Mailing Address:
SUITE C300
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334-1980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-996-1020
Provider Business Mailing Address Fax Number:
248-996-1023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32910 W 13 MILE RD
Provider Second Line Business Practice Location Address:
SUITE C300
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-1980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-996-1020
Provider Business Practice Location Address Fax Number:
248-996-1023
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHEYNSON
Authorized Official First Name:
ALEXSEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
248-996-1020

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144640 . This is a "PREFERRED CHOICE PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1770773905 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4858214620 . This is a "FERNANDO QUIRINDONGO BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1497804306 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1760614390 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4856314380 . This is a "ALEXSEY KHEYNSON BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1598984189 . This is a "NPI FOR DALEY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1598984189 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480H229190 . This is a "BC GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: V02502 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 025519 . This is a "MIDWEST ADV" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1134212889 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1487771473 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 480F367590 . This is a "BC GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4856316840 . This is a "BC FOR DALEY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1952373201 . This is a "NPI FOR ALEX" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4935003 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134235088 . This is a "NPI FERNANDO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DG0290 . This is a "MT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: V09910 . This is a "HAP FERN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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