Provider Demographics
NPI:1992931059
Name:SHELBY FOOT & ANKLE, PLLC
Entity type:Organization
Organization Name:SHELBY FOOT & ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-580-3728
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3139
Mailing Address - Country:US
Mailing Address - Phone:586-580-3728
Mailing Address - Fax:586-580-3769
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3139
Practice Address - Country:US
Practice Address - Phone:586-484-7894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG002058213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty