Provider Demographics
NPI:1588770358
Name:ELITE PODIATRY PC
Entity type:Organization
Organization Name:ELITE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEYNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-996-1020
Mailing Address - Street 1:32910 W 13 MILE RD
Mailing Address - Street 2:SUITE C300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1980
Mailing Address - Country:US
Mailing Address - Phone:248-996-1020
Mailing Address - Fax:248-996-1023
Practice Address - Street 1:32910 W 13 MILE RD
Practice Address - Street 2:SUITE C300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1980
Practice Address - Country:US
Practice Address - Phone:248-996-1020
Practice Address - Fax:248-996-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144640OtherPREFERRED CHOICE PPO
MI1770773905Medicaid
MI4858214620OtherFERNANDO QUIRINDONGO BC
MI1497804306OtherNPI
MI1760614390OtherNPI
MI4856314380OtherALEXSEY KHEYNSON BC
MI1598984189OtherNPI FOR DALEY
MI1598984189Medicaid
MI480H229190OtherBC GROUP
MIV02502OtherHAP
MI025519OtherMIDWEST ADV
MI1134212889OtherNPI
MI1487771473OtherNPI
MI480F367590OtherBC GROUP
MI4856316840OtherBC FOR DALEY
MI1952373201OtherNPI FOR ALEX
MI4935003Medicaid
MI1134235088OtherNPI FERNANDO
MIDG0290OtherMT
MIV09910OtherHAP FERN
MI025521OtherMIDWEST DALEY
MI4935012Medicaid
MI1760614390OtherNPI
MIV02502Medicare UPIN
MI1598984189Medicaid
MI1770773905Medicaid
MIV02502OtherHAP
MI4935003Medicaid
MI4935012Medicaid
MI144640OtherPREFERRED CHOICE PPO
MI1598984189OtherNPI FOR DALEY
MIP3462002Medicare PIN