Individual
HAFSA ABID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
11900 E 12 MILE RD STE 102, WARREN, MI 48093-3487
(586) 573-7470
(586) 573-0850
Mailing address
11900 E 12 MILE RD STE 102, WARREN, MI 48093-3487
(586) 573-7470
(586) 573-0850
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/25/2026
Last updated
04/25/2026
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