Provider Demographics
NPI:1174607527
Name:WOODY VITALE, DEBBIE D (DPM)
Entity type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:D
Last Name:WOODY VITALE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19723 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1021
Mailing Address - Country:US
Mailing Address - Phone:734-479-8383
Mailing Address - Fax:734-479-8382
Practice Address - Street 1:19723 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1021
Practice Address - Country:US
Practice Address - Phone:734-479-8383
Practice Address - Fax:734-479-8382
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW001734213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU61479Medicare UPIN
MIMI7296Medicare PIN
MI4858251480OtherBCBS