Organization
LAKEVIEW PODIATRY ASSOC P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY PUPP DPM (PHYSICIAN)
(248) 424-8637
Entity
Organization
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
5901000690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H2788
BCBSM
MI
01
—
0M07610
MEDICARE
MI
05
—
4275305
—
MI
01
—
T34213
HAP PROVIDER #
MI
Enumeration date
07/11/2006
Last updated
10/17/2017
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