Provider Demographics
NPI:1578731204
Name:FAMILY FOOT CLINIC, P.C.
Entity Type:Organization
Organization Name:FAMILY FOOT CLINIC, P.C.
Other - Org Name:FOOT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-270-7627
Mailing Address - Street 1:1675 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-270-7627
Mailing Address - Fax:972-270-7759
Practice Address - Street 1:221 WEST COLORADO
Practice Address - Street 2:SUITE 340
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-943-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0425213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1292660001Medicare NSC
00Y938Medicare PIN