Healthcare Provider Details

I. General information

NPI: 1003943861
Provider Name (Legal Business Name): ANKLE & FOOT ASSOCIATES OF NORTHERN MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 LAKE ST
ROSCOMMON MI
48653-7663
US

IV. Provider business mailing address

408 LAKE STREET P.O. BOX 949
ROSCOMMON MI
48653
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-3668
  • Fax:
Mailing address:
  • Phone: 989-275-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002144
License Number StateMI

VIII. Authorized Official

Name: DR. BRIAN M BRAUSA
Title or Position: CO-PRESIDENT
Credential: D.P.M.
Phone: 989-275-3668