Provider Demographics
NPI:1972635829
Name:STEVEN R MIGDALEWICZ DPM PC
Entity type:Organization
Organization Name:STEVEN R MIGDALEWICZ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIGDALEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-624-5835
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001589213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F365460OtherBCBSM
MI4856354340OtherBCBS PROVIDER ID
MI480034036OtherRAILROAD PROVIDER ID
MI134375070Medicaid
MI5208690001Medicare NSC
MI0N41610Medicare ID - Type Unspecified
MI134375070Medicaid
MI480F365460OtherBCBSM