Provider Demographics
NPI:1699775015
Name:UNGAR, DAVID SAM (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAM
Last Name:UNGAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34435 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3309
Mailing Address - Country:US
Mailing Address - Phone:248-477-3301
Mailing Address - Fax:248-478-2829
Practice Address - Street 1:34435 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3309
Practice Address - Country:US
Practice Address - Phone:248-477-3301
Practice Address - Fax:248-478-2829
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDU001140213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F318570OtherBLUE CROSS BLUE SHIELD
MI2842540Medicaid
MI1891836243OtherGROUP NPI
MI1891836243OtherGROUP NPI
MI0457410001Medicare NSC
MI2842540Medicaid