Provider Demographics
NPI:1598062036
Name:FOOT SPECIALISTS PC
Entity Type:Organization
Organization Name:FOOT SPECIALISTS PC
Other - Org Name:THE FOOT CARE INSTITUTE OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-478-1150
Mailing Address - Street 1:21111 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5549
Mailing Address - Country:US
Mailing Address - Phone:248-478-1150
Mailing Address - Fax:248-478-1156
Practice Address - Street 1:11650 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3380
Practice Address - Country:US
Practice Address - Phone:734-699-2400
Practice Address - Fax:734-699-3669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-18
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F364180OtherBLUE CROSS BLUE SHIELD
MI54938DOtherHAP
MI480F364180OtherBLUE CROSS BLUE SHIELD