Provider Demographics
NPI:1467620021
Name:D DIABETIC FOOT CENTRE AND WALKING INSTITUTE, LLC
Entity Type:Organization
Organization Name:D DIABETIC FOOT CENTRE AND WALKING INSTITUTE, LLC
Other - Org Name:SAGE THOMAS FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EA
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-691-0971
Mailing Address - Street 1:12745 S SAGINAW ST
Mailing Address - Street 2:SUITE 806
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-695-6950
Mailing Address - Fax:
Practice Address - Street 1:12745 S SAGINAW ST
Practice Address - Street 2:SUITE 806
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2437
Practice Address - Country:US
Practice Address - Phone:810-695-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001885213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480B518380OtherBCBS PIN
MI480B518380OtherBCBS PIN
MI6097700001Medicare NSC
MIU75955Medicare UPIN