Provider Demographics
NPI:1962602565
Name:STERLING HEIGHTS UTICA PODIATRISTS PC
Entity type:Organization
Organization Name:STERLING HEIGHTS UTICA PODIATRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-254-2420
Mailing Address - Street 1:8061 21 MILE RD
Mailing Address - Street 2:SUITE 1&2
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4311
Mailing Address - Country:US
Mailing Address - Phone:586-254-2420
Mailing Address - Fax:586-254-2447
Practice Address - Street 1:8061 21 MILE RD
Practice Address - Street 2:SUITE 1&2
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4311
Practice Address - Country:US
Practice Address - Phone:586-254-2420
Practice Address - Fax:586-254-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000675213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4885053950OtherBCBS OF MICHIGAN
MI1360298Medicaid
MIT34069Medicare UPIN
MI1360298Medicaid