MEDICARE: DR MARTINS FOOT AND ANKLE CLINIC

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

General Provider Information

NPI Number	:	1891397402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MARTINS FOOT AND ANKLE CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 3038
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48106-3038
Country	:	US
Telephone Number	:	517-879-4241
Fax Number	:	517-879-4240

Provider Business Practice Location Address
First Line	:	4335 JACKSON RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1831
Country	:	US
Telephone Number	:	517-879-4241
Fax Number	:	517-879-4240

Authorized Official
Title or Position	:	OWNER
Name	:	DARRYL J MARTINS
Credential	:
Telephone Number	:	517-879-4241

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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