Provider Demographics
NPI:1215044276
Name:FAMILY FOOT CLINIC P.C.
Entity Type:Organization
Organization Name:FAMILY FOOT CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:906-863-5585
Mailing Address - Street 1:4320 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-1314
Mailing Address - Country:US
Mailing Address - Phone:906-863-5585
Mailing Address - Fax:906-863-8420
Practice Address - Street 1:4320 10TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-1314
Practice Address - Country:US
Practice Address - Phone:906-863-5585
Practice Address - Fax:906-863-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43226700Medicaid
MI4855525230OtherBC BS PROVIDER NUMBER
MI4099852Medicaid
WI090003914OtherWEA PRIVATE INSURANCE
MI4099852Medicaid
WI43226700Medicaid
MION94950Medicare ID - Type UnspecifiedMICHIGAN MEDICARE NUMBER