JERAD ROLAND BOOTH (NPI# 1316562515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316562515 |
| Entity Type | Individual |
| Full Name | JERAD ROLAND BOOTH |
| Practice Address |
22201 Moross Rd Ste 250 Detroit MI 48236-2175 |
| Practice Telephone | 3133433423 |
| Practice Fax Number | 3133433401 |
| Mailing Telephone | 3133433423 |
| Mailing Fax Number | 3133433401 |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2020-06-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 5951001368 | MI | Podiatric Medicine & Surgery Service Providers |
| Street Address |
22201 MOROSS RD STE 250 |
| City | DETROIT |
| State | MI |
| Zip Code | 48236-2175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992155576 | Chinenye Ezike | Podiatrist | 22201 Moross Rd Ste 250, Detroit, MI 48236-2175 | 2016-06-15 |
| 1588217905 | Amida Kuah | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd Ste 250, Detroit, MI 48236-2175 | 2019-07-24 |
| 1568923944 | Rhennetta Bork | Student in an Organized Health Care Education/Training Program | 22201 Moross Rd Ste 250, Detroit, MI 48236-2175 | 2019-03-27 |
| 1740774751 | Tyler James Zimmermann | Podiatrist | 22201 Moross Rd Ste 250, Detroit, MI 48236 | 2018-06-22 |
| 1417307679 | Anthony Mollica | Podiatrist | 22201 Moross Rd Ste 250, Detroit, MI 48236-2175 | 2016-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093323966 | Khairya Fatouh | Pathology | 22101 Morros Road, Pathology Department, Detroit, Detroit, MI 48236 | 2020-07-16 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1801449483 | Ishaq Azeem Asghar | Student in an Organized Health Care Education/Training Program | 22101 Moross Road, Pathology Department, Detroit, MI 48236 | 2019-07-22 |
| 1295290443 | Ascension St. John Hospital | Dietitian, Registered | 22201 Moross, Ste. 270, Detriot, MI 48236 | 2019-02-01 |
| 1548747413 | Abiodun Adenuga Adefarasin | Pharmacist | 20746 Mack Avenue, Gross Pointe Woods, MI 48236 | 2018-07-24 |
| 1629564042 | Hamza H Khan | Student in an Organized Health Care Education/Training Program | 22201 Moross, Professional Building 2, Suite 70, Detroit, MI 48236 | 2018-07-09 |
| 1235631664 | David Lee Williams | Physical Therapist | 159 Kercheval Avenue, Grosse Pointe Farms, MI 48236 | 2018-03-01 |
| 1164979720 | Memphie Morgan | Licensed Practical Nurse | 91527 Cheshire St., Grosse Pointe, MI 48236 | 2016-09-01 |
| Find all providers in zip 48236 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124422233 | Arnold S. Gross, Dpm PC | Podiatrist | 18254 Livernois Ave Ste 2, Detroit, MI 48221-4214 | 2014-10-17 |
| 1366629594 | Lawrence B Rubin Dpm PC | Podiatrist | 18530 Grand River, Detroit, MI 48223 | 2008-01-30 |
| 1912116807 | 7-huntington Podiatry Associates PC | Podiatrist | 19350 West Seven Mile Rd, Detroit, MI 48219 | 2007-05-21 |
| 1447471669 | Wendy W. Webster Dpm,pc | Podiatrist | 19933 Livernois Ave, Ste B, Detroit, MI 48221-1234 | 2007-05-02 |
| 1538200019 | James Schelberg | Podiatrist | 500 Griswold St, Ste 1b, Detroit, MI 48226-3480 | 2007-02-09 |
| 1578651253 | Ralph J Zicherman | Podiatrist | 18663 Livernois Avenue, Detroit, MI 48221 | 2006-10-10 |
| 1245327543 | Charles Marvin Johnson | Podiatrist | 10244 W 7 Mile Rd, Detroit, MI 48221-1904 | 2006-10-06 |
| 1326153537 | Ronald A Hackelman | Podiatrist | 634 Chene Street, Detroit, MI 48207 | 2006-08-20 |
| 1336252857 | Podiatry Examiners of Michigan PC | Podiatrist | 3800 Woodward Avenue, Suite 318, Detroit, MI 48201-2066 | 2006-08-17 |
| 1992734727 | Sylvia L Loving | Podiatrist | 18300 W Mcnichols Rd, Detroit, MI 48219-4162 | 2006-07-02 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.