Provider Demographics
NPI:1679197438
Name:PODIATRY INSTITUTE OF MICHIGAN
Entity type:Organization
Organization Name:PODIATRY INSTITUTE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-472-2700
Mailing Address - Street 1:10501 TELEGRAPH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3376
Mailing Address - Country:US
Mailing Address - Phone:734-472-2700
Mailing Address - Fax:734-472-2701
Practice Address - Street 1:10501 TELEGRAPH RD STE 104
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3376
Practice Address - Country:US
Practice Address - Phone:734-472-2700
Practice Address - Fax:734-472-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty