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Organization

LONG LAKE PODIATRY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMY DOOLEY (OFFICE MANAGER)
(248) 528-0709
Entity
Organization

Contact information

Practice address
2914 E LONG LAKE RD, TROY, MI 48085-3780
(248) 528-0709
(248) 528-1807
Mailing address
2914 E LONG LAKE RD, TROY, MI 48085-3780
(248) 528-0709
(248) 528-1807

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901001005
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005335144
AETNA
MI
05
1634294
MI
01
480002521
RAILROAD MCR
MI
01
5631470
BLUE CROSS BLUE SHIELD
MI
01
89594B
HAP
MI
Enumeration date
03/19/2007
Last updated
09/30/2025
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