Provider Demographics
NPI:1194120824
Name:ERIC J. FOREMAN, DPM PC
Entity type:Organization
Organization Name:ERIC J. FOREMAN, DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-646-6882
Mailing Address - Street 1:31500 TELEGRAPH RD STE 235
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4315
Mailing Address - Country:US
Mailing Address - Phone:248-646-6882
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 1175
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2188
Practice Address - Country:US
Practice Address - Phone:248-646-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG000942213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2109403Medicaid
MI0N9340Medicare PIN