Provider Demographics
NPI:1518990936
Name:MEDIC ONE VISITING FOOT CARE AND ASSOCIATES PC
Entity Type:Organization
Organization Name:MEDIC ONE VISITING FOOT CARE AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-983-5687
Mailing Address - Street 1:33424 DEQUINDRE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5878
Mailing Address - Country:US
Mailing Address - Phone:586-983-5687
Mailing Address - Fax:586-983-5517
Practice Address - Street 1:33424 DEQUINDRE RD
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5878
Practice Address - Country:US
Practice Address - Phone:586-983-5687
Practice Address - Fax:586-983-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001013213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION54670Medicare ID - Type Unspecified