Provider Demographics
NPI:1215029418
Name:CLAWSON FOOTCARE SPECIALISTS PC
Entity Type:Organization
Organization Name:CLAWSON FOOTCARE SPECIALISTS PC
Other - Org Name:BRIAN E. HOMER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PC
Authorized Official - Phone:248-288-8900
Mailing Address - Street 1:615 W. 14 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1901
Mailing Address - Country:US
Mailing Address - Phone:248-288-8900
Mailing Address - Fax:248-288-8989
Practice Address - Street 1:615 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1901
Practice Address - Country:US
Practice Address - Phone:248-288-8900
Practice Address - Fax:248-288-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001699261QP1100X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI133153308Medicaid
MI480018640OtherRAILROAD MEDICARE
MI0F383890OtherBCBSMI DME
MI1283450001OtherMEDICARE DME
MI0F31808OtherBCBSMI
MI480018640OtherRAILROAD MEDICARE
MI1283450001Medicare NSC