Provider Demographics
NPI:1386615797
Name:POPLAR PODIATRY PC
Entity type:Organization
Organization Name:POPLAR PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-681-9141
Mailing Address - Street 1:993 REDDOCH CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3614
Mailing Address - Country:US
Mailing Address - Phone:901-681-9141
Mailing Address - Fax:901-681-9149
Practice Address - Street 1:993 REDDOCH CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3614
Practice Address - Country:US
Practice Address - Phone:901-681-9141
Practice Address - Fax:901-681-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4879940002Medicare NSC
TN3353727Medicare PIN