Provider Demographics
NPI:1699887083
Name:JOHN THROCKMORTON, DPM PC
Entity type:Organization
Organization Name:JOHN THROCKMORTON, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-882-8673
Mailing Address - Street 1:3390 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8547
Mailing Address - Country:US
Mailing Address - Phone:517-882-8673
Mailing Address - Fax:517-882-3935
Practice Address - Street 1:3390 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8547
Practice Address - Country:US
Practice Address - Phone:517-882-8673
Practice Address - Fax:517-882-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000906213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000005897OtherPHYSICIANS HEALTH PLAN
MI01007577OtherHEALTH PLUS
MI1002614OtherMCLAREN HEALTH
MI200000005897OtherPHYSICIANS HEALTH PLAN
MI01007577OtherHEALTH PLUS
MI0P36190Medicare PIN
MI0971420001Medicare NSC