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 | 5901BH001699 | MICHIGAN | 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 | 0F383890 | OTHER | MICHIGAN | BCBS DME CLAWSON |
| 2 | 4319060001 | OTHER | MICHIGAN | ALLEN PARK DME |
| 3 | 480018640 | OTHER | MICHIGAN | MEDICARE RAILROAD CLAWSON |
| 4 | ON31390 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | ALLEN PARK MEDICARE |
| 5 | 0H20650 | OTHER | MICHIGAN | BCBS DME ALLEN PART |
| 6 | P00102057 | OTHER | MICHIGAN | MEDICARE RAILROAD ALLEN PARK |
| 7 | U43805 | MEDICARE UPIN | MICHIGAN | |
| 8 | ON31400 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | CLAWSON MEDICARE NUMBER |
| 9 | 1283450001 | OTHER | MICHIGAN | CLAWSON DME NUMBER |
| 10 | 480F318080 | OTHER | MICHIGAN | BLUE CROSS -CLAWSON |
| 11 | 48OH2128370 | OTHER | MICHIGAN | ALLEN PARK BLUE CROSS |