Healthcare Provider Details

I. General information

NPI: 1609150382
Provider Name (Legal Business Name): DETROIT METRO FOOT & ANKLE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 10/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 S MAIN ST
PLYMOUTH MI
48170-2093
US

IV. Provider business mailing address

906 S MAIN ST
PLYMOUTH MI
48170-2093
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-3669
  • Fax: 734-455-3797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002303
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002290
License Number StateMI

VIII. Authorized Official

Name: DR. HATIM T BURHANI
Title or Position: DOCTOR
Credential: D.P.M.
Phone: 734-455-3669