Healthcare Provider Details

I. General information

NPI: 1750307385
Provider Name (Legal Business Name): MICHIGAN FOOT AND ANKLE CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 LEVAN RD SUITE E302
LIVONIA MI
48154-5083
US

IV. Provider business mailing address

9400 S CICERO AVE STE 100
OAK LAWN IL
60453-2536
US

V. Phone/Fax

Practice location:
  • Phone: 734-591-6612
  • Fax: 734-591-6621
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN FRASCONE
Title or Position: CMO
Credential: DPM
Phone: 586-725-3444