Provider Demographics
NPI:1306922760
Name:SPRUNGER, TAD D (DPM)
Entity type:Individual
Prefix:DR
First Name:TAD
Middle Name:D
Last Name:SPRUNGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 INVESTMENT DR
Mailing Address - Street 2:STE 280
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098
Mailing Address - Country:US
Mailing Address - Phone:248-312-0767
Mailing Address - Fax:248-312-0840
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:STE 280
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-312-0767
Practice Address - Fax:248-312-0840
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001984213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4624291Medicaid
MI4624291Medicaid
MIN89650002Medicare PIN