Healthcare Provider Details

I. General information

NPI: 1083892178
Provider Name (Legal Business Name): ANN ARBOR FOOT CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 DEXTER RD
ANN ARBOR MI
48103-2702
US

IV. Provider business mailing address

2550 DEXTER RD
ANN ARBOR MI
48103-2702
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-9111
  • Fax: 734-994-4410
Mailing address:
  • Phone: 734-994-9111
  • Fax: 734-994-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002011
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901002011
License Number StateMI

VIII. Authorized Official

Name: DR. LORI ANN SHELDON
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 734-994-9111