Healthcare Provider Details

I. General information

NPI: 1780855221
Provider Name (Legal Business Name): MOSS FOOT CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27501 WARREN RD
GARDEN CITY MI
48135-2253
US

IV. Provider business mailing address

27501 WARREN RD
GARDEN CITY MI
48135-2253
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-7111
  • Fax: 734-427-1377
Mailing address:
  • Phone: 734-427-7111
  • Fax: 734-427-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number001094
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID MOSS
Title or Position: OWNER/MEMBER
Credential: DPM
Phone: 734-427-7111