1588770358 NPI number — ELITE PODIATRY PC

Table of content: DR. ANN MARIE BROZ M.D. (NPI 1457614760)

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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