Healthcare Provider Details

I. General information

NPI: 1568501062
Provider Name (Legal Business Name): DELTA FOOT CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 W KALAMAZOO ST
LANSING MI
48917-3653
US

IV. Provider business mailing address

3802 W KALAMAZOO ST
LANSING MI
48917-3653
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-7300
  • Fax: 517-485-7301
Mailing address:
  • Phone: 517-485-7300
  • Fax: 517-485-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberBG001798
License Number StateMI

VIII. Authorized Official

Name: DR. BRIAN SPENCER GOOSEN
Title or Position: OWNER
Credential: DPM
Phone: 517-485-7300