Provider Demographics
NPI:1962620823
Name:MOTYER, MICHAEL G (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:MOTYER
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 1:1 CAYLOR-NICKEL SQ.
Mailing Address - Street 2:STE 100 CAYLOR-NICKEL CLINIC
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714
Mailing Address - Country:US
Mailing Address - Phone:260-824-3500
Mailing Address - Fax:260-919-3551
Practice Address - Street 1:1 CAYLOR NICKEL SQ
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2529
Practice Address - Country:US
Practice Address - Phone:260-919-3302
Practice Address - Fax:260-919-3551
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000209213E00000X
IN07001062A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200940600Medicaid
911080H9Medicare PIN