Provider Demographics
NPI:1639195696
Name:ROMEO FOOT CLINIC, PC
Entity Type:Organization
Organization Name:ROMEO FOOT CLINIC, PC
Other - Org Name:ROMEO FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STIEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-752-3519
Mailing Address - Street 1:64580 VAN DYKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2811
Mailing Address - Country:US
Mailing Address - Phone:586-752-3519
Mailing Address - Fax:586-752-7046
Practice Address - Street 1:64580 VAN DYKE RD STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2811
Practice Address - Country:US
Practice Address - Phone:586-752-3519
Practice Address - Fax:586-752-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICJ7750OtherPALMETTO GBA RAILROAD MED
MI480E021140OtherBLUE CROSS BLUE SHIELD
MI480E021140OtherBLUE CARE NETWORK
MI=========OtherCOMMERCIAL
MI480E021140OtherBLUE CARE NETWORK
MI0Q37610Medicare PIN