MEDICARE: CRANBROOK FOOT SURGEONS

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0E01608	OTHER		BCBSM
2	8505002	OTHER		BCBSM

General Provider Information

NPI Number	:	1689847089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANBROOK FOOT SURGEONS

Provider Business Mailing Address
First Line	:	2009 E 14 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5905
Country	:	US
Telephone Number	:	586-978-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 E 14 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5905
Country	:	US
Telephone Number	:	586-978-3336
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS M BIFULCO
Credential	:	DPM
Telephone Number	:	586-978-3336

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	04/17/2008

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