Provider Demographics
NPI:1750307385
Name:MICHIGAN FOOT AND ANKLE CENTER P C
Entity Type:Organization
Organization Name:MICHIGAN FOOT AND ANKLE CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-725-3444
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE E302
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-591-6612
Mailing Address - Fax:734-591-6621
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE E302
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-591-6612
Practice Address - Fax:734-591-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H224360OtherBLUE CROSS SUPPLIER NUMBE
MI480H217100OtherBLUE CROSS
MI=========OtherTAX ID
MI480H217100OtherBLUE CROSS
MI0M94620Medicare ID - Type Unspecified