Provider Demographics
NPI:1831539030
Name:ANKLE AND FOOTCARE SPECIALIST PLC
Entity type:Organization
Organization Name:ANKLE AND FOOTCARE SPECIALIST PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-284-7600
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:STE 307
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-458-3614
Mailing Address - Fax:
Practice Address - Street 1:23234 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1769
Practice Address - Country:US
Practice Address - Phone:313-284-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6357310001Medicare NSC