Provider Demographics
NPI:1962968719
Name:MINI INVASIVE PODIATRY PLC
Entity type:Organization
Organization Name:MINI INVASIVE PODIATRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATEYAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-303-6195
Mailing Address - Street 1:1607 E BIG BEAVER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2067
Mailing Address - Country:US
Mailing Address - Phone:586-434-3444
Mailing Address - Fax:586-434-3445
Practice Address - Street 1:1607 E BIG BEAVER RD STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2067
Practice Address - Country:US
Practice Address - Phone:586-434-3444
Practice Address - Fax:586-434-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962968719OtherORGANIZATION NPI