Provider Demographics
NPI:1861401994
Name:BIANCHI, ANTHONY J (DPM)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:BIANCHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3566 CONNIE LN
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4103
Mailing Address - Country:US
Mailing Address - Phone:810-824-1376
Mailing Address - Fax:810-294-5049
Practice Address - Street 1:3566 CONNIE LN
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4103
Practice Address - Country:US
Practice Address - Phone:810-824-1376
Practice Address - Fax:810-294-5049
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001442213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2886017Medicaid
MI2886017Medicaid
T96782Medicare UPIN