Provider Demographics
NPI:1891222964
Name:AUSTIN, SAMUEL THADDEUS (DPM)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THADDEUS
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:22720 MICHIGAN AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2000
Mailing Address - Country:US
Mailing Address - Phone:248-717-0000
Mailing Address - Fax:248-617-0006
Practice Address - Street 1:22720 MICHIGAN AVE STE 175
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2000
Practice Address - Country:US
Practice Address - Phone:248-717-0000
Practice Address - Fax:248-617-0006
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2025-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5901400369213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery