Provider Demographics
NPI:1699737064
Name:NORTHVILLE FAMILY FOOT SPECIALISTS PLLC
Entity type:Organization
Organization Name:NORTHVILLE FAMILY FOOT SPECIALISTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-349-3900
Mailing Address - Street 1:42925 W 7 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-349-3900
Mailing Address - Fax:248-349-3851
Practice Address - Street 1:42925 W 7 MILE ROAD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-349-3900
Practice Address - Fax:248-349-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM000602213E00000X
MIRY000639213E00000X
MIJJ000709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N56190003Medicare PIN
N56190001Medicare PIN
MIT34386Medicare UPIN
MIT34213Medicare UPIN
MIT34421Medicare UPIN