Healthcare Provider Details

I. General information

NPI: 1508066853
Provider Name (Legal Business Name): FOOT SOLUTIONS LIVONIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19239 NEWBURGH RD
LIVONIA MI
48152-1026
US

IV. Provider business mailing address

19239 NEWBURGH RD
LIVONIA MI
48152-1026
US

V. Phone/Fax

Practice location:
  • Phone: 734-591-3338
  • Fax: 734-591-1255
Mailing address:
  • Phone: 734-591-3338
  • Fax: 734-591-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BROZOVICH
Title or Position: OWNER
Credential: C. PED
Phone: 734-591-3338