Provider Demographics
NPI:1740228451
Name:FREELAND FOOT AND ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:FREELAND FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VONDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-695-6788
Mailing Address - Street 1:7305 MIDLAND RD
Mailing Address - Street 2:STE. 2
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8410
Mailing Address - Country:US
Mailing Address - Phone:989-695-6788
Mailing Address - Fax:989-695-6491
Practice Address - Street 1:7305 MIDLAND RD
Practice Address - Street 2:STE. 2
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8410
Practice Address - Country:US
Practice Address - Phone:989-695-6788
Practice Address - Fax:989-695-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N85660Medicare PIN