Provider Demographics
NPI:1285623777
Name:COMMUNITY FOOT CENTERS PC
Entity type:Organization
Organization Name:COMMUNITY FOOT CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WASIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-887-3729
Mailing Address - Street 1:2997 E HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-2811
Mailing Address - Country:US
Mailing Address - Phone:248-887-3729
Mailing Address - Fax:248-889-8910
Practice Address - Street 1:2997 E HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48356-2811
Practice Address - Country:US
Practice Address - Phone:248-887-3729
Practice Address - Fax:248-889-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000651213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5825393OtherBCBSM
MI1062554Medicaid
MI1062554Medicaid
MI0528670002Medicare NSC
MI5825393OtherBCBSM
MI0528670001Medicare NSC