Provider Demographics
NPI:1902890627
Name:MIGDALEWICZ, STEVEN RONALD (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RONALD
Last Name:MIGDALEWICZ
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 1:30750 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1589
Mailing Address - Country:US
Mailing Address - Phone:248-624-5835
Mailing Address - Fax:248-624-7961
Practice Address - Street 1:30750 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1589
Practice Address - Country:US
Practice Address - Phone:248-624-5835
Practice Address - Fax:248-624-7961
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001589213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856354340OtherBLUE CROSS BLUE SHIELD
MI2976670Medicaid
MI4375070Medicaid
MI2976670Medicaid
U30475Medicare UPIN
MI5208690Medicare ID - Type Unspecified