Individual
DR. GUY RICHARD PUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
22250 PROVIDENCE DR STE 100, SOUTHFIELD, MI 48075-6209
(248) 424-8637
(248) 424-8663
Mailing address
22250 PROVIDENCE DR STE 100, SOUTHFIELD, MI 48075-6209
(248) 424-8637
(248) 424-8663
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
GP000690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4275305
—
MI
01
—
479116001
DME SUPPLIER #
MI
01
—
OH 27788
BCBS
MI
01
—
T34213
HAP PROVIDER #
MI
Enumeration date
02/24/2006
Last updated
03/29/2018
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