Provider Demographics
NPI:1760679070
Name:ANKLE AND FOOT CENTER PC
Entity Type:Organization
Organization Name:ANKLE AND FOOT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-324-3322
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:640 ROMENCE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3464
Practice Address - Country:US
Practice Address - Phone:269-324-3322
Practice Address - Fax:269-324-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001711213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4853956160OtherBCBSM
MI4853956160OtherBCBSM
MIU46498Medicare UPIN
MI0M12710Medicare PIN
MI0913530001Medicare NSC