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 | | 5901000829 | 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 | 128831 | OTHER | | PREFERRED HEALTH PLAN |
2 | 27582 | OTHER | MICHIGAN | OMNICARE |
3 | 381910031 | OTHER | MICHIGAN | DMC PPO |
4 | T34416 | MEDICARE UPIN | | |
5 | 50051 | OTHER | MICHIGAN | OMNICARE |
6 | 480024166 | OTHER | | RAILROAD MEDICARE |
7 | 4949608 | MEDICAID | MICHIGAN | |
8 | 0F37115002 | MEDICARE PIN | MICHIGAN | |
9 | 0P37900003 | MEDICARE PIN | | |
10 | 0452330001 | OTHER | | ADMINASTAR DME |
11 | DR630728 | OTHER | MICHIGAN | PARTNER HEALTH |
12 | 1002247-0003 | OTHER | MICHIGAN | THE WELLNESS PLAN |
13 | 3297999 | MEDICAID | MICHIGAN | |
14 | LH000829 | OTHER | MICHIGAN | BLUE SHIELD |
15 | 128831 | OTHER | MICHIGAN | CARE CHOICES |
16 | 1308930 | MEDICAID | MICHIGAN | |
17 | 5987390001 | MEDICARE NSC | | |
18 | 0828050001 | MEDICARE NSC | | |
19 | LH000829 | OTHER | | BLUE SHIELD FEDERAL EMPL |
20 | 574381 | OTHER | | FIRST HEALTH |
21 | 791480382 | OTHER | | RAILROAD MEDICARE |
22 | 0F37115002 | OTHER | MICHIGAN | BLUE SHIELD |
23 | 15990 | OTHER | MICHIGAN | GREAT LAKES HEALTH PLAN |
24 | 4426972 | OTHER | | AETNA |
25 | 480F335300 | OTHER | MICHIGAN | BLUE SHIELD |
26 | T34416 | OTHER | MICHIGAN | HEALTH ALLIANCE PLAN |
27 | 4426972 | OTHER | | UNITED HEALTH CARE |
28 | 480F311010 | OTHER | MICHIGAN | BLUE SHIELD |
29 | 0N66020001 | MEDICARE PIN | MICHIGAN | |