Healthcare Provider Details

I. General information

NPI: 1194646612
Provider Name (Legal Business Name): DR MARTINS FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S COOPER ST
JACKSON MI
49201-1598
US

IV. Provider business mailing address

100 S COOPER ST
JACKSON MI
49201-1598
US

V. Phone/Fax

Practice location:
  • Phone: 517-879-4242
  • Fax: 517-879-4240
Mailing address:
  • Phone: 517-879-4242
  • Fax: 517-879-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANIELKA MARTINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 734-239-5161