Provider Demographics
NPI:1871563510
Name:MOBILE PODIATRY ASSOCIATES, P.L.L.C.
Entity type:Organization
Organization Name:MOBILE PODIATRY ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-355-9300
Mailing Address - Street 1:27718 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2352
Mailing Address - Country:US
Mailing Address - Phone:248-355-9300
Mailing Address - Fax:248-355-3626
Practice Address - Street 1:27718 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2352
Practice Address - Country:US
Practice Address - Phone:248-355-9300
Practice Address - Fax:248-355-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F31881OtherBCBSMI
0N43460Medicare ID - Type Unspecified
0N43450Medicare ID - Type Unspecified
5062430001Medicare NSC