Provider Demographics
NPI:1306942842
Name:BC PODIATRY PLLC
Entity type:Organization
Organization Name:BC PODIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BURKARDT
Authorized Official - Last Name:DPM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-308-2973
Mailing Address - Street 1:31017 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1907
Mailing Address - Country:US
Mailing Address - Phone:248-585-1177
Mailing Address - Fax:248-585-0083
Practice Address - Street 1:31017 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1907
Practice Address - Country:US
Practice Address - Phone:248-585-1177
Practice Address - Fax:248-585-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI213E00000X, 213ES0103X
332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F337000OtherBLUE CROSS BLUE SHIELD
MI480F337000OtherBLUE CROSS FEP
MIMI1200OtherMEDICARE PTAN
MICN3339OtherRAILROAD
MI0P41010OtherMEDICARE
MI0P41010OtherMEDICARE PLUS BLUE
MI0P41010OtherMEDICARE ADVANTAGE
MI4480020001OtherMEDICARE DMERC
MI480F337000OtherBLUE CARE NETWORK
MIMI1200OtherMEDICARE PTAN
MIMI1200OtherMEDICARE PTAN