Provider Demographics
NPI:1902108152
Name:BC PODIATRY PLLC
Entity Type:Organization
Organization Name:BC PODIATRY PLLC
Other - Org Name:GENTLE FOOT & ANKLE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BURKARDT
Authorized Official - Last Name:DPM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-308-2973
Mailing Address - Street 1:13650 TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9143
Mailing Address - Country:US
Mailing Address - Phone:248-486-1177
Mailing Address - Fax:
Practice Address - Street 1:13650 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9143
Practice Address - Country:US
Practice Address - Phone:248-486-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
MI5901001043332B00000X
MI5901002128332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F337000OtherBLUE CARE NETWORK
480F394250OtherBLUE CROSS
MI480F337000OtherBLUE CROSS BLUE SHIELD
MI0P15390OtherMEDICARE
MI0P15390OtherMEDICARE PLUS BLUE
MI492996413Medicaid
480F394250OtherBLUE CROSS
MI492996413Medicaid