Provider Demographics
NPI:1053508341
Name:HOUSE CALL FOOT SPECIALISTS PLLC
Entity Type:Organization
Organization Name:HOUSE CALL FOOT SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-610-0489
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-0262
Mailing Address - Country:US
Mailing Address - Phone:313-610-0489
Mailing Address - Fax:
Practice Address - Street 1:32747 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48173-8634
Practice Address - Country:US
Practice Address - Phone:313-610-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002098213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P28200Medicare PIN