Provider Demographics
NPI:1154344588
Name:HYGAIT PODIATRY PC
Entity type:Organization
Organization Name:HYGAIT PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-822-2007
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-0157
Mailing Address - Country:US
Mailing Address - Phone:616-822-2007
Mailing Address - Fax:616-899-5358
Practice Address - Street 1:2155 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:MI
Practice Address - Zip Code:49403-9598
Practice Address - Country:US
Practice Address - Phone:616-822-2007
Practice Address - Fax:616-899-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001927213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4854110970OtherBLUECROSSBLUE SHIELD MI
MI4854110970OtherBLUECROSSBLUE SHIELD MI
MI0N87190Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER