Provider Demographics
NPI:1689847089
Name:CRANBROOK FOOT SURGEONS
Entity Type:Organization
Organization Name:CRANBROOK FOOT SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIFULCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-978-3336
Mailing Address - Street 1:2009 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5905
Mailing Address - Country:US
Mailing Address - Phone:586-978-3336
Mailing Address - Fax:
Practice Address - Street 1:2009 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5905
Practice Address - Country:US
Practice Address - Phone:586-978-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E01608OtherBCBSM
8505002OtherBCBSM
0E01608OtherBCBSM
T34404Medicare UPIN
4837870001Medicare NSC