Provider Demographics
NPI:1528330420
Name:GREAT LAKES FOOT CARE P.C.
Entity type:Organization
Organization Name:GREAT LAKES FOOT CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-338-3668
Mailing Address - Street 1:1701 BALDWIN AVE
Mailing Address - Street 2:B
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3412
Mailing Address - Country:US
Mailing Address - Phone:248-338-3668
Mailing Address - Fax:248-338-0136
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:B
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-338-3668
Practice Address - Fax:248-338-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1536220Medicaid
MI5630125OtherBLUE CROSS BLUE SHIELD
MI5630125OtherBLUE CROSS BLUE SHIELD
MI5635110Medicare PIN
MI1536220Medicaid