Provider Demographics
NPI:1609150382
Name:DETROIT METRO FOOT & ANKLE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:DETROIT METRO FOOT & ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HATIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-455-3669
Mailing Address - Street 1:906 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:906 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2093
Practice Address - Country:US
Practice Address - Phone:734-455-3669
Practice Address - Fax:734-455-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002303213ES0103X
MI5901002290213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty