Provider Demographics
NPI:1366086886
Name:PREFERRED PODIATRY GROUP OF MICHIGAN PC
Entity type:Organization
Organization Name:PREFERRED PODIATRY GROUP OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-841-5200
Mailing Address - Street 1:PO BOX 772294
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2294
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:
Practice Address - Street 1:225 W WASHINGTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3485
Practice Address - Country:US
Practice Address - Phone:847-502-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty