Provider Demographics
NPI:1154391985
Name:SOUTHGATE FOOT AND ANKLE CENTER PLLC
Entity type:Organization
Organization Name:SOUTHGATE FOOT AND ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZAHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-285-4200
Mailing Address - Street 1:14535 NORTHLINE RD.
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2446
Mailing Address - Country:US
Mailing Address - Phone:734-285-4200
Mailing Address - Fax:734-285-9256
Practice Address - Street 1:14535 NORTHLINE RD.
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2446
Practice Address - Country:US
Practice Address - Phone:734-285-4200
Practice Address - Fax:734-285-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDZ400138261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF6579OtherMEDICARE RETIRED RAILROAD
MI4390835Medicaid
MI4390835Medicaid
MI4207740001Medicare NSC
MI0P43870Medicare PIN