Healthcare Provider Details

I. General information

NPI: 1134787054
Provider Name (Legal Business Name): BJC FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8548 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

IV. Provider business mailing address

8548 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-3864
  • Fax: 810-958-1174
Mailing address:
  • Phone: 810-227-3864
  • Fax: 810-958-1174

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: DR. BRYANT CASTELEIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 810-227-3864