Provider Demographics
NPI:1194871202
Name:FAMILY FOOT AND ANKLE CENTER, P.C.
Entity type:Organization
Organization Name:FAMILY FOOT AND ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-667-4663
Mailing Address - Street 1:3801 WILDER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2301
Mailing Address - Country:US
Mailing Address - Phone:989-667-4663
Mailing Address - Fax:989-667-1964
Practice Address - Street 1:295 MAPLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9352
Practice Address - Country:US
Practice Address - Phone:989-667-4663
Practice Address - Fax:989-667-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M22980Medicare ID - Type Unspecified