Provider Demographics
NPI:1386783470
Name:DARRYL KOMPUS DPM PLLC
Entity type:Organization
Organization Name:DARRYL KOMPUS DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KOMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-540-2549
Mailing Address - Street 1:18508 DEVONSHIRE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-672-4655
Mailing Address - Fax:
Practice Address - Street 1:15101 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4611
Practice Address - Country:US
Practice Address - Phone:313-582-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001659213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5820969OtherBLUE CROSS BLUE SHIELD
MI4125602Medicaid
MI4125602Medicaid
U33672Medicare UPIN