Provider Demographics
NPI:1518035542
Name:FAMILY FOOT CARE CENTER, PLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MAIKON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-393-4343
Mailing Address - Street 1:3359 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5568
Mailing Address - Country:US
Mailing Address - Phone:319-393-4343
Mailing Address - Fax:319-393-4464
Practice Address - Street 1:3359 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5568
Practice Address - Country:US
Practice Address - Phone:319-393-4343
Practice Address - Fax:319-393-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00487213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8722Medicare ID - Type Unspecified