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 | 213E00000X | Podiatrist | | | | 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 | V02502 | OTHER | MICHIGAN | HAP |
| 2 | 1497804306 | OTHER | MICHIGAN | NPI |
| 3 | 1487771473 | OTHER | MICHIGAN | NPI |
| 4 | V09910 | MEDICARE UPIN | MICHIGAN | |
| 5 | 4856316840 | OTHER | MICHIGAN | BC FOR DALEY |
| 6 | P34620001 | MEDICARE PIN | MICHIGAN | |
| 7 | P3462002 | MEDICARE PIN | MICHIGAN | |
| 8 | P34620007 | MEDICARE PIN | MICHIGAN | |
| 9 | 1952373201 | OTHER | MICHIGAN | NPI FOR ALEX |
| 10 | 5957970001 | MEDICARE NSC | MICHIGAN | |
| 11 | 1487771473 | MEDICARE PIN | MICHIGAN | |
| 12 | 1760614390 | MEDICARE PIN | MICHIGAN | |
| 13 | V09910 | OTHER | MICHIGAN | HAP FERN |
| 14 | DG0290 | OTHER | MICHIGAN | MT |
| 15 | 480F367590 | OTHER | MICHIGAN | BC GROUP |
| 16 | 480H229190 | OTHER | MICHIGAN | BC GROUP |
| 17 | 1134212889 | OTHER | MICHIGAN | NPI |
| 18 | 1134235088 | OTHER | MICHIGAN | NPI FERNANDO |
| 19 | P34620003 | MEDICARE PIN | MICHIGAN | |
| 20 | P34620012 | MEDICARE PIN | MICHIGAN | |
| 21 | 4856314380 | OTHER | MICHIGAN | ALEXSEY KHEYNSON BC |
| 22 | 1770773905 | MEDICAID | MICHIGAN | |
| 23 | 1598984189 | MEDICAID | MICHIGAN | |
| 24 | 025519 | OTHER | MICHIGAN | MIDWEST ADV |
| 25 | 025521 | OTHER | MICHIGAN | MIDWEST DALEY |
| 26 | 1760614390 | OTHER | MICHIGAN | NPI |
| 27 | V02502 | MEDICARE UPIN | MICHIGAN | |
| 28 | 4935012 | MEDICAID | MICHIGAN | |
| 29 | 4935003 | MEDICAID | MICHIGAN | |
| 30 | 4858214620 | OTHER | MICHIGAN | FERNANDO QUIRINDONGO BC |
| 31 | 1598984189 | OTHER | MICHIGAN | NPI FOR DALEY |
| 32 | 144640 | OTHER | MICHIGAN | PREFERRED CHOICE PPO |