Provider Demographics
NPI:1841231891
Name:FOOT AND ANKLE ASSOC. PLLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE ASSOC. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-347-8233
Mailing Address - Street 1:PO BOX 3195
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3195
Mailing Address - Country:US
Mailing Address - Phone:248-347-8233
Mailing Address - Fax:248-347-8174
Practice Address - Street 1:44000 W 12 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3111
Practice Address - Country:US
Practice Address - Phone:248-347-8233
Practice Address - Fax:248-347-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001597213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI613133100OtherDEPT OF LABOR
MI4480692Medicaid
MI480F303840OtherBCBS GROUP
MI4856354790OtherBCBS
MI480F303840OtherBCBS GROUP
MIU41652Medicare UPIN