Provider Demographics
NPI:1275703266
Name:FAMILY PODIATRISTS,P.C.
Entity Type:Organization
Organization Name:FAMILY PODIATRISTS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:KANER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-888-9500
Mailing Address - Street 1:24230 KARIM BLVD
Mailing Address - Street 2:STE#140
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2960
Mailing Address - Country:US
Mailing Address - Phone:248-888-9500
Mailing Address - Fax:248-888-9504
Practice Address - Street 1:24230 KARIM BLVD
Practice Address - Street 2:STE#140
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2960
Practice Address - Country:US
Practice Address - Phone:248-888-9500
Practice Address - Fax:248-888-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000553213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1124460Medicaid
4383238OtherAETNA US HEALTHCARE
U20248Medicare UPIN
MI1124460Medicaid