Provider Demographics
NPI:1831730985
Name:ADVANTAGE FOOT AND ANKLE SPECIALISTS PLLC
Entity type:Organization
Organization Name:ADVANTAGE FOOT AND ANKLE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-965-2927
Mailing Address - Street 1:3055 HILTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1096
Mailing Address - Country:US
Mailing Address - Phone:248-965-2927
Mailing Address - Fax:248-965-2912
Practice Address - Street 1:3055 HILTON RD STE C
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1096
Practice Address - Country:US
Practice Address - Phone:248-965-2927
Practice Address - Fax:248-965-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty