Healthcare Provider Details

I. General information

NPI: 1407564545
Provider Name (Legal Business Name): FOOT HEALTHCARE ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S LATSON RD STE 320
HOWELL MI
48843-7661
US

IV. Provider business mailing address

37595 7 MILE RD STE 370
LIVONIA MI
48152-1489
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-0001
  • Fax: 248-258-6779
Mailing address:
  • Phone: 248-258-0001
  • Fax: 248-258-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA J FENN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-258-0001