MEDICARE: FOOT CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	MH400209	MI

General Provider Information

NPI Number	:	1316126345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT CLINIC PC

Provider Business Mailing Address
First Line	:	3601 E WILDER
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706
Country	:	US
Telephone Number	:	989-667-3668
Fax Number	:	989-667-3670

Provider Business Practice Location Address
First Line	:	3601 WILDER RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2113
Country	:	US
Telephone Number	:	989-667-3668
Fax Number	:	989-667-3670

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL HOLLAND
Credential	:
Telephone Number	:	989-667-3668

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	02/25/2011

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