Provider Demographics
NPI:1851846257
Name:PREMIER FOOT & ANKLE PLLC
Entity Type:Organization
Organization Name:PREMIER FOOT & ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MILITELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-557-7233
Mailing Address - Street 1:PO BOX 380984
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0074
Mailing Address - Country:US
Mailing Address - Phone:586-557-7233
Mailing Address - Fax:
Practice Address - Street 1:17900 23 MILE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1161
Practice Address - Country:US
Practice Address - Phone:586-557-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002316213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty