Provider Demographics
NPI:1265458814
Name:MICHIGAN FOOT AND ANKLE CENTER PC
Entity Type:Organization
Organization Name:MICHIGAN FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-725-3444
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:586-725-3444
Mailing Address - Fax:586-725-0984
Practice Address - Street 1:24725 W 12 MILE RD STE 270
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8310
Practice Address - Country:US
Practice Address - Phone:248-353-9300
Practice Address - Fax:248-353-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H224360OtherBLUE CROSS SUPPLIER
MI480H217100OtherBLUE CROSS
MI4263940001Medicare NSC