Organization
MICHIGAN ASSOCIATES IN PODIATRIC MEDICINE AND SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DINA M JEGLA (OFFICE MANAGER)
(248) 674-2575
Entity
Organization
Contact information
Practice address
3560 PONTIAC LAKE RD, WATERFORD, MI 48328-2337
(248) 674-2575
(248) 674-0577
Mailing address
5379 PLEASANT LAKE DR, WEST BLOOMFIELD, MI 48322-4715
(248) 674-2575
(248) 674-0577
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000581
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
094460
MEDICARE PTAN
MI
05
—
427339213
—
MI
Enumeration date
03/22/2007
Last updated
10/19/2010
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