Healthcare Provider Details

I. General information

NPI: 1801910229
Provider Name (Legal Business Name): EAST SIDE FOOT & ANKLE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22301 GREATER MACK AVE SUITE 3
SAINT CLAIR SHORES MI
48080-2376
US

IV. Provider business mailing address

22301 GREATER MACK AVE SUITE 3
SAINT CLAIR SHORES MI
48080-2376
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-7000
  • Fax: 586-776-7003
Mailing address:
  • Phone: 586-776-7000
  • Fax: 586-776-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001005
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5901001005
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID BERLIN
Title or Position: OWNER
Credential: D.P.M.
Phone: 586-776-7000