Provider Demographics
NPI:1366056665
Name:RADU PURTUC DPM PLLC
Entity type:Organization
Organization Name:RADU PURTUC DPM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RADU
Authorized Official - Middle Name:
Authorized Official - Last Name:PURTUC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:224-587-8126
Mailing Address - Street 1:43191 DALCOMA DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6308
Mailing Address - Country:US
Mailing Address - Phone:586-213-5250
Mailing Address - Fax:586-213-5252
Practice Address - Street 1:43191 DALCOMA DR STE 105
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6308
Practice Address - Country:US
Practice Address - Phone:586-213-5250
Practice Address - Fax:586-213-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty