Provider Demographics
NPI:1790938926
Name:NORTHERN FOOT & ANKLE CENTERS PC
Entity Type:Organization
Organization Name:NORTHERN FOOT & ANKLE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:PILICHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-354-3309
Mailing Address - Street 1:4656 E F 41
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-2227
Mailing Address - Country:US
Mailing Address - Phone:989-354-3309
Mailing Address - Fax:989-354-9190
Practice Address - Street 1:4656 E F 41
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-2227
Practice Address - Country:US
Practice Address - Phone:989-354-3309
Practice Address - Fax:989-354-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP001908213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4140770001Medicare NSC
MI4140770002Medicare NSC
ON21940Medicare PIN