Provider Demographics
NPI:1780859603
Name:MID-OAKLAND FOOT CARE, P,L.L.C.
Entity Type:Organization
Organization Name:MID-OAKLAND FOOT CARE, P,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-625-3100
Mailing Address - Street 1:5905 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2990
Mailing Address - Country:US
Mailing Address - Phone:248-625-3100
Mailing Address - Fax:248-625-1855
Practice Address - Street 1:5905 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2990
Practice Address - Country:US
Practice Address - Phone:248-625-3100
Practice Address - Fax:248-625-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI590100001084213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI485635084OtherBLUE CROSS BLUE SHIELD
MI13 4228477Medicaid
MI13 4228477Medicaid
MI485635084OtherBLUE CROSS BLUE SHIELD
MIT34141Medicare UPIN
MI4120340001Medicare NSC