Healthcare Provider Details

I. General information

NPI: 1891310553
Provider Name (Legal Business Name): KAKOS PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 FORT ST STE 8
SOUTHGATE MI
48195-1348
US

IV. Provider business mailing address

14825 SOUTHFIELD RD
ALLEN PARK MI
48101-2642
US

V. Phone/Fax

Practice location:
  • Phone: 734-281-6320
  • Fax: 734-281-2866
Mailing address:
  • Phone: 313-383-7071
  • Fax: 313-383-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FADEE KAKOS
Title or Position: OWNER
Credential: DPM
Phone: 313-383-7071