Provider Demographics
NPI:1457450702
Name:MOBILE FOOT CARE PC
Entity Type:Organization
Organization Name:MOBILE FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SEHGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-565-2111
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353
Mailing Address - Country:US
Mailing Address - Phone:517-548-4738
Mailing Address - Fax:517-548-4752
Practice Address - Street 1:301 LAKE MEADOW DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1785
Practice Address - Country:US
Practice Address - Phone:313-565-2111
Practice Address - Fax:313-565-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F318900OtherBC
MI480F318900OtherBC
MIU67055Medicare UPIN