Provider Demographics
NPI:1962570853
Name:ASSOCIATED FOOT CLINIC OF FENTON, P.C.
Entity type:Organization
Organization Name:ASSOCIATED FOOT CLINIC OF FENTON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOROYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-750-8300
Mailing Address - Street 1:191 N PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362
Mailing Address - Country:US
Mailing Address - Phone:810-693-8400
Mailing Address - Fax:810-693-3970
Practice Address - Street 1:102 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2670
Practice Address - Country:US
Practice Address - Phone:810-750-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJN001106213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI48-0B514890OtherBCBSM
MIT34145Medicare UPIN
MAU66465Medicare UPIN
MIT34326Medicare UPIN
MI0P39620Medicare PIN
MI6017140001Medicare NSC