Provider Demographics
NPI:1689859399
Name:ANKLE AND FOOT SPECIALTY CLINICS
Entity Type:Organization
Organization Name:ANKLE AND FOOT SPECIALTY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-414-3338
Mailing Address - Street 1:416 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1047
Mailing Address - Country:US
Mailing Address - Phone:810-414-3338
Mailing Address - Fax:
Practice Address - Street 1:416 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1047
Practice Address - Country:US
Practice Address - Phone:810-414-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001810213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P06400Medicare PIN
MIU62910Medicare UPIN
MI4825510001Medicare NSC