Provider Demographics
NPI:1689862666
Name:OMNI FOOTCARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:OMNI FOOTCARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-247-0840
Mailing Address - Street 1:13811 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2705
Mailing Address - Country:US
Mailing Address - Phone:586-247-0840
Mailing Address - Fax:586-247-7668
Practice Address - Street 1:13811 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2705
Practice Address - Country:US
Practice Address - Phone:586-247-0840
Practice Address - Fax:586-247-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAW001164213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI83069BOtherHAP
MIAW001164OtherSTATE LICENSE
MI870453OtherUNITED HEALTHCARE
MIC7479OtherM CARE
MI4662672OtherAETNA
MI1710645Medicaid
MI480E021060OtherBCBSM
MI4885050380OtherBCBS
MIDE4368OtherRAILROAD MEDICARE PART B
MI104435OtherGREAT LAKES
MI870453OtherUNITED HEALTHCARE
MI83069BOtherHAP