Provider Demographics
NPI:1194922559
Name:MICHIGAN FOOT & ANKLE SURGEONS, P.C.
Entity type:Organization
Organization Name:MICHIGAN FOOT & ANKLE SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-355-4000
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-355-4000
Mailing Address - Fax:248-355-4047
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-355-4000
Practice Address - Fax:248-355-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFL000635213ES0103X
MIRL002077213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669497327OtherRANDY NPI
MI4741574Medicaid
1528091378OtherFRED NPI
1669497327OtherRANDY NPI
U99844Medicare UPIN
T34388Medicare UPIN
0N91070002Medicare ID - Type Unspecified