Provider Demographics
NPI:1750552022
Name:MICHIGAN CITY FOOT
Entity type:Organization
Organization Name:MICHIGAN CITY FOOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSOUTSOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-844-2020
Mailing Address - Street 1:7330 INDIANAPOLIS BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2941
Mailing Address - Country:US
Mailing Address - Phone:219-844-2020
Mailing Address - Fax:
Practice Address - Street 1:1403 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3707
Practice Address - Country:US
Practice Address - Phone:219-874-8515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN484900CMedicare PIN
IN484900Medicare PIN