Provider Demographics
NPI:1699319806
Name:FOOT & ANKLE SPECIALISTS OF MID-MICHIGAN PC
Entity type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF MID-MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-488-6355
Mailing Address - Street 1:111 E WACKERLY ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7043
Mailing Address - Country:US
Mailing Address - Phone:989-488-6355
Mailing Address - Fax:989-486-9051
Practice Address - Street 1:111 E WACKERLY ST STE B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7043
Practice Address - Country:US
Practice Address - Phone:989-488-6355
Practice Address - Fax:989-486-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty