Healthcare Provider Details

I. General information

NPI: 1891397402
Provider Name (Legal Business Name): DR MARTINS FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4335 JACKSON RD
ANN ARBOR MI
48103-1831
US

IV. Provider business mailing address

PO BOX 3038
ANN ARBOR MI
48106-3038
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-4241
  • Fax: 517-879-4240
Mailing address:
  • Phone: 517-879-4241
  • Fax: 517-879-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

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