Provider Demographics
NPI:1891397402
Name:DR MARTINS FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:DR MARTINS FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-879-4241
Mailing Address - Street 1:PO BOX 3038
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3038
Mailing Address - Country:US
Mailing Address - Phone:517-879-4241
Mailing Address - Fax:517-879-4240
Practice Address - Street 1:4335 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1831
Practice Address - Country:US
Practice Address - Phone:517-879-4241
Practice Address - Fax:517-879-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty