Provider Demographics
NPI:1497822712
Name:FEET FIRST P C
Entity Type:Organization
Organization Name:FEET FIRST P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-624-8338
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:S-1175
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-624-8338
Mailing Address - Fax:248-926-9498
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:S-1175
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-624-8338
Practice Address - Fax:248-926-9498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEET FIRST PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5357612OtherAETNA
MI480F318320OtherBLUE CROSS BLUE SHIELD
MI=========OtherPPOM
MI0N11860Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER