Provider Demographics
NPI:1285802033
Name:GREAT STEPS CLINIC PC
Entity type:Organization
Organization Name:GREAT STEPS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIFULCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-978-3336
Mailing Address - Street 1:2009 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5905
Mailing Address - Country:US
Mailing Address - Phone:586-978-3336
Mailing Address - Fax:
Practice Address - Street 1:2009 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5905
Practice Address - Country:US
Practice Address - Phone:586-978-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITB000751332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4837870001Medicare NSC
T34404Medicare UPIN