Healthcare Provider Details

I. General information

NPI: 1770988925
Provider Name (Legal Business Name): DR MARTINS FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N MAIN ST STE C
ADRIAN MI
49221
US

IV. Provider business mailing address

PO BOX 67
ADRIAN MI
49221-0067
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-4241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002348
License Number StateMI

VIII. Authorized Official

Name: DR. DARRYL J MARTINS
Title or Position: OWNER
Credential: DPM
Phone: 517-879-4241