| Organization Name: | EASTSIDE PODIATRY PLC |
| NPI Number: | 1144377821 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIMITRIOS PANAGOPOULOS (OWNER) |
| Mailing Address: | 20835 Mack Ave Grosse Pointe Woods |
| State: | MI US |
| Postal Code: | 482361486 |
| Phone Number: | 3138847566 |
| Fax Number: | 3138843140 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 04/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 5901002021 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |