Provider Demographics
NPI:1497873319
Name:TOTAL FOOT & ANKLE CLINIC P C
Entity Type:Organization
Organization Name:TOTAL FOOT & ANKLE CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-238-3338
Mailing Address - Street 1:PO BOX 13507
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-3507
Mailing Address - Country:US
Mailing Address - Phone:810-238-3338
Mailing Address - Fax:810-238-9577
Practice Address - Street 1:3725 S SAGINAW ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4321
Practice Address - Country:US
Practice Address - Phone:810-238-3338
Practice Address - Fax:810-238-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI59010000989213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4151747-13Medicaid
MI480034386OtherPALMETTO GBA
MI4852550010OtherBLUE CROSS
MI5409890001OtherDME
MI4852550010OtherBLUE CROSS
MI480034386OtherPALMETTO GBA