Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000453 | MI |
NPI | 1295727378 |
---|---|
Provider Name | Dr. Nelson Joseph Pont |
First Address | Dearborn Heights, MI 48127-1489 |
Second Address | Dearborn Heights, MI 48127-1489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295727378 | (02) | MI |
4816170001 | DMERC (01) | MI |
8825378 | BLUECROSS BLUESHIELD (01) | MI |