Provider Demographics
NPI:1699076455
Name:TENDER FOOT & ANKLE CARE PLLC
Entity type:Organization
Organization Name:TENDER FOOT & ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROLLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-298-1585
Mailing Address - Street 1:48467 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3282
Mailing Address - Country:US
Mailing Address - Phone:586-298-1585
Mailing Address - Fax:
Practice Address - Street 1:48467 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-3282
Practice Address - Country:US
Practice Address - Phone:586-298-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002345261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F36404028OtherMEDICARE ID NO.
0F36404028OtherMEDICARE ID NO.