| Spartan Podiatry Pc | |
|
1600 South Kalamazoo Ave., Marshall, MI 49068 | |
| (269) 781-4700 | |
| (269) 781-7168 |
| Full Name | Spartan Podiatry Pc |
|---|---|
| Type | Facility |
| Speciality | Podiatrist - Primary Podiatric Medicine |
| Location | 1600 South Kalamazoo Ave., Marshall, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467664904 | NPI | - | NPPES |
| 485135002 | Other | MI | BCBS DR. JAMES GRAY |
| 211332613 | Medicaid | MI | |
| 485135003 | Other | MI | BCBS DR. WILLIAM GRAY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213EP1101X | Podiatrist - Primary Podiatric Medicine | WG000970 (Michigan) | Primary |
| Provider Name | James M Gray |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1508952821 PECOS PAC ID: 4688850530 Enrollment ID: I20110511000168 |
| Provider Name | Angela L Robin |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1952662538 PECOS PAC ID: 8224359831 Enrollment ID: I20150608002939 |
| Provider Name | Carl R Jay |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1376981290 PECOS PAC ID: 1254651805 Enrollment ID: I20191121000790 |
| Provider Name | Matthew Quang Dang |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1619464518 PECOS PAC ID: 3971867359 Enrollment ID: I20210721001342 |
| Provider Name | Rene Siazon Juridico |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1720566466 PECOS PAC ID: 5395131957 Enrollment ID: I20220407000398 |
| Mailing Address | Practice Location Address |
|---|---|
| Spartan Podiatry Pc 1600 South Kalamazoo Ave., Marshall, MI 49068 Ph: (269) 781-4700 | Spartan Podiatry Pc 1600 South Kalamazoo Ave., Marshall, MI 49068 Ph: (269) 781-4700 |
Dr. James M Gray, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1170 W Mich Ave, Marshall, MI 49068 Phone: 269-781-4700 Fax: 269-781-7168 | |
Rene Siazon Juridico, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1600 S Kalamazoo Ave Ste A, Marshall, MI 49068 Phone: 269-781-4700 Fax: 269-781-7168 | |
Angela Louise Robin, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1600 S Kalamazoo Ave, Marshall, MI 49068 Phone: 269-781-4700 | |
Dr. William J Gray, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1170 W Mich Ave, Marshall, MI 49068 Phone: 269-781-4700 Fax: 269-781-7168 |