Provider Demographics
NPI:1801361365
Name:PREMIER FOOT & ANKLE PLLC
Entity Type:Organization
Organization Name:PREMIER FOOT & ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANO
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MILITELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-948-9417
Mailing Address - Street 1:17900 23 MILE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1161
Mailing Address - Country:US
Mailing Address - Phone:586-948-9417
Mailing Address - Fax:586-846-3910
Practice Address - Street 1:5777 W MAPLE RD STE 170
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4448
Practice Address - Country:US
Practice Address - Phone:586-948-9417
Practice Address - Fax:586-846-3910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FOOT & ANKLE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty