Provider Demographics
NPI:1992985881
Name:ADVANCED FOOT CARE, P.C.
Entity type:Organization
Organization Name:ADVANCED FOOT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDANT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-731-7873
Mailing Address - Street 1:41400 DEQUINDRE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3763
Mailing Address - Country:US
Mailing Address - Phone:586-731-7873
Mailing Address - Fax:586-731-7912
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3763
Practice Address - Country:US
Practice Address - Phone:586-731-7873
Practice Address - Fax:586-731-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003760001Medicare NSC
MIT34127Medicare UPIN