Provider Demographics
NPI:1386916351
Name:KAREN POTCHYNOK, D.P.M., P.C.
Entity type:Organization
Organization Name:KAREN POTCHYNOK, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POTCHYNOK-LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-228-9660
Mailing Address - Street 1:18645 CANAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5822
Mailing Address - Country:US
Mailing Address - Phone:586-228-9660
Mailing Address - Fax:586-228-1324
Practice Address - Street 1:18645 CANAL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5822
Practice Address - Country:US
Practice Address - Phone:586-228-9660
Practice Address - Fax:586-228-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty