Provider Demographics
NPI:1619214855
Name:FOOT HEALTHCARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:FOOT HEALTHCARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-258-0001
Mailing Address - Street 1:37595 7 MILE RD STE 370
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1003
Mailing Address - Country:US
Mailing Address - Phone:248-258-0001
Mailing Address - Fax:248-258-6779
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 502
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-258-0001
Practice Address - Fax:248-258-6779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT HEALTHCARE ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001143213E00000X
MI5901002465213E00000X
MI5901002233213E00000X
MI5901002271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215913694OtherNPI
MI1902096902OtherNPI
MI5901002465OtherPODIATRIC PHYSICAN & SURGEON
MI1457593162OtherNPI
MI5901001143OtherPODIATRYIC PHYSICIAN & SURGEON
MI1821253022OtherNPI
MI5901002233OtherPODIATRIC PHYSICIAN & SURGEON
MI0611170003OtherMEDICARE DME
MI5901002271OtherPODIATRIC PHYSICIAN & SURGEON
MI0F36404035Medicare PIN
MI1457593162OtherNPI
MI0611170003Medicare NSC
MI5901002271OtherPODIATRIC PHYSICIAN & SURGEON
MI5901001143OtherPODIATRYIC PHYSICIAN & SURGEON
MI0F36404Medicare PIN