Healthcare Provider Details

I. General information

NPI: 1548754229
Provider Name (Legal Business Name): ROYAL OAK FOOT & ANKLE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 S WASHINGTON AVE
ROYAL OAK MI
48067
US

IV. Provider business mailing address

1026 S WASHINGTON AVE
ROYAL OAK MI
48067-3218
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-4311
  • Fax:
Mailing address:
  • Phone: 248-541-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberTS001939
License Number StateMI

VIII. Authorized Official

Name: ELIZABETH SAYWARD SNYDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-541-4311