Provider Demographics
NPI:1861429524
Name:WEXLER, LARRY H (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:H
Last Name:WEXLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33566 W 8 MILE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5271
Mailing Address - Country:US
Mailing Address - Phone:248-476-5288
Mailing Address - Fax:
Practice Address - Street 1:33566 W 8 MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5271
Practice Address - Country:US
Practice Address - Phone:248-476-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0940213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4699590001OtherMEDICARE DME
MI2110905Medicaid
MIOF32236OtherBC/BS OF MICHIGAN DME
MI5631568OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4699590001Medicare NSC
MIOF32236OtherBC/BS OF MICHIGAN DME
MI2110905Medicaid