Provider Demographics
NPI:1417620170
Name:GREAT LAKES FOOT & ANKLE INSTITUTE PLLC
Entity Type:Organization
Organization Name:GREAT LAKES FOOT & ANKLE INSTITUTE PLLC
Other - Org Name:GREAT LAKES FOOT & ANKLE INSTITUTE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
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 1:32743 23 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2082
Practice Address - Country:US
Practice Address - Phone:586-725-3444
Practice Address - Fax:586-725-0984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT LAKES FOOT & ANKLE INSTITUTE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty