Provider Demographics
NPI:1104941400
Name:CAPITAL FOOT & ANKLE CENTERS, PC
Entity type:Organization
Organization Name:CAPITAL FOOT & ANKLE CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-853-8951
Mailing Address - Street 1:2843 E GRAND RIVER AVE
Mailing Address - Street 2:#235
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6722
Mailing Address - Country:US
Mailing Address - Phone:517-853-8951
Mailing Address - Fax:517-913-5996
Practice Address - Street 1:2270 JOLLY OAK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4528
Practice Address - Country:US
Practice Address - Phone:517-853-8951
Practice Address - Fax:517-913-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG002023213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4892840001Medicare NSC