Provider Demographics
NPI:1932279437
Name:NATIONWIDE FOOT & ANKLE CARE PC
Entity Type:Organization
Organization Name:NATIONWIDE FOOT & ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-261-3400
Mailing Address - Street 1:10986 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3058
Mailing Address - Country:US
Mailing Address - Phone:734-261-3400
Mailing Address - Fax:734-261-3411
Practice Address - Street 1:10986 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:734-261-3400
Practice Address - Fax:734-261-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI493538013Medicaid
MI493538013Medicaid
MI6142480001Medicare NSC