| NPI | 1508004920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN GEORGE LODER Owner 586-329-3895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901001662) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2022-11-02 |