Provider Demographics
NPI:1659460863
Name:FOOT AND ANKLE SPECIALISTS OF MICHIGAN PLLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-574-0500
Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-545-0100
Mailing Address - Fax:
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-545-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICK000960OtherLICENSE
MIJF001355OtherLICENSE
MILH000829OtherLICENSE
MIMS000843OtherLICENSE
MI5987390001OtherDME
MIDG2153OtherMEDICARE RAILROAD
MI480F335300OtherBCBS
MI480F335300OtherBLUECARE NETWORK
MILH000829OtherLICENSE
MI480F335300OtherBLUECARE NETWORK