Provider Demographics
NPI:1962589481
Name:ANTHONY GIORDANO DPM PC
Entity type:Organization
Organization Name:ANTHONY GIORDANO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-812-3194
Mailing Address - Street 1:19832 DEMIL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6313
Mailing Address - Country:US
Mailing Address - Phone:734-812-3194
Mailing Address - Fax:
Practice Address - Street 1:51523 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4447
Practice Address - Country:US
Practice Address - Phone:734-812-3194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002058213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139161OtherCARE CHOICES
MI139161OtherPREFERRED CHOICES
MI4939263Medicaid
MIV02089Medicare UPIN
MI139161OtherPREFERRED CHOICES
MI4939263Medicaid