Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 5901002333 | OTHER | MICHIGAN | JENNIFER L PETRONELLA DPM STATE LICENSE |
| 2 | 4778520001 | MEDICARE NSC | MICHIGAN | |
| 3 | 5901001605 | OTHER | MICHIGAN | G DANIEL SHANAHAN IV DPM STATE LICENSE |
| 4 | 1003818907 | OTHER | | G. D SHANAHAN DPM NPI # |
| 5 | N78970 | OTHER | | MEDICARE GROUP NUMBER |
| 6 | 1770712358 | OTHER | | JENNIFER L PETRONELLA DPM NPI NUMBER |
| 7 | 5901002236 | OTHER | MICHIGAN | AIMEE A. POPOFSKI STATE LICENSE |
| 8 | U43179 | MEDICARE UPIN | | |
| 9 | U61949 | MEDICARE UPIN | | |
| 10 | 1790880284 | OTHER | | AIMEE A. POPOFSKI DPM NPI NUMBER |
| 11 | 480F321940 | OTHER | MICHIGAN | BLUE CROSS BLUE SHIELD |
