Provider Demographics
NPI:1295072445
Name:FOOT HEALTHCARE ASSOCIATES, PC
Entity type:Organization
Organization Name:FOOT HEALTHCARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-258-0001
Mailing Address - Street 1:37595 7 MILE RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1003
Mailing Address - Country:US
Mailing Address - Phone:248-258-0001
Mailing Address - Fax:248-258-6779
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:SUITE 370
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:248-258-0001
Practice Address - Fax:248-258-6779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT HEALTHCARE ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002271213E00000X
MI5901001143213E00000X
MI5901002233213E00000X
MI5901002465213E00000X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215913694OtherNPI
MI1902096902OtherNPI
MI5901002465OtherPODIATRIC PHYSICIAN LICENSE
MI1821253022OtherNPI
MI5901001143OtherPODIATRIC PHYSICIAN LISCENSE
MI5901002271OtherPODIATRIC PHYSICIAN LISCENSE
MI1457593162OtherNPI
MI5901002233OtherPODIATRIC PHYSICIAN LISCENSE
MI1902096902OtherNPI
MI0F36404Medicare PIN
MI0F36404035Medicare PIN
MI0F36404002Medicare PIN
MI5901002271OtherPODIATRIC PHYSICIAN LISCENSE
MI1457593162OtherNPI