Provider Demographics
NPI:1083892178
Name:ANN ARBOR FOOT CLINIC P.C.
Entity Type:Organization
Organization Name:ANN ARBOR FOOT CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-994-9111
Mailing Address - Street 1:2550 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2702
Mailing Address - Country:US
Mailing Address - Phone:734-994-9111
Mailing Address - Fax:734-994-4410
Practice Address - Street 1:2550 DEXTER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2702
Practice Address - Country:US
Practice Address - Phone:734-994-9111
Practice Address - Fax:734-994-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002011213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
480H16064OtherBLUE CROSS/BLUE SHIELD
4858150120OtherBLUE TRADITIONAL & TRUST
4858150120OtherBLUE TRADITIONAL & TRUST
MI0439630001Medicare NSC
MI0N16720Medicare PIN