Provider Demographics
NPI:1548442858
Name:DAVID R HUNTER DPM PC
Entity type:Organization
Organization Name:DAVID R HUNTER DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:231-347-3440
Mailing Address - Street 1:2233 MITCHELL PARK DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9600
Mailing Address - Country:US
Mailing Address - Phone:231-347-3440
Mailing Address - Fax:231-347-4828
Practice Address - Street 1:1104 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2710
Practice Address - Country:US
Practice Address - Phone:906-635-9511
Practice Address - Fax:906-635-9529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID R HUNTER DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH5901001212213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1310710002OtherCIGNA GOVERNMENT SERVICES
MI0B44565OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MICK0985Medicare PIN
TN1310710002OtherCIGNA GOVERNMENT SERVICES