Organization Name: | DEXTER PODIATRY, PC |
NPI Number: | 1043475726 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTI LEDBETTER (PRESIDENT / OWNER) |
Mailing Address: | 7300 Dexter Ann Arbor Rd Suite 100 Dexter |
State: | MI US |
Postal Code: | 481308598 |
Phone Number: | 7342532687 |
Fax Number: | 7342532697 |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 09/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 5901002092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |