Provider Demographics
NPI:1851586515
Name:FAMILY FOOTCARE OF MID-MICHIGAN, P.C.
Entity Type:Organization
Organization Name:FAMILY FOOTCARE OF MID-MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-775-8500
Mailing Address - Street 1:1205 S MISSION ST
Mailing Address - Street 2:STE. 11
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3939
Mailing Address - Country:US
Mailing Address - Phone:989-775-8500
Mailing Address - Fax:
Practice Address - Street 1:1205 S MISSION ST
Practice Address - Street 2:STE. 11
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3939
Practice Address - Country:US
Practice Address - Phone:989-775-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001836261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N19440Medicare PIN
MI4183340001Medicare NSC