Provider Demographics
NPI:1427083492
Name:MICHIGAN FOOT & ANKLE INSTITUTE PC
Entity type:Organization
Organization Name:MICHIGAN FOOT & ANKLE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOWALCHICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-228-2255
Mailing Address - Street 1:44250 GARFIELD RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7421
Mailing Address - Country:US
Mailing Address - Phone:586-228-2255
Mailing Address - Fax:586-228-2740
Practice Address - Street 1:44250 GARFIELD RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7421
Practice Address - Country:US
Practice Address - Phone:586-228-2255
Practice Address - Fax:586-228-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEK001446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E015510OtherBLUE CROSS BLUE SHIELD MI
MI123659200OtherWORKERS COMPENSATION
MIDB9371OtherRAILROAD MEDICARE
MI0E015510OtherBLUE CROSS BLUE SHIELD MI
MI5171240001Medicare NSC
MI0E015510OtherBLUE CROSS BLUE SHIELD MI