Healthcare Provider Details

I. General information

NPI: 1518990936
Provider Name (Legal Business Name): MEDIC ONE VISITING FOOT CARE AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33424 DEQUINDRE RD SUITE A
STERLING HEIGHTS MI
48310-5878
US

IV. Provider business mailing address

33424 DEQUINDRE RD SUITE A
STERLING HEIGHTS MI
48310-5878
US

V. Phone/Fax

Practice location:
  • Phone: 586-983-5687
  • Fax: 586-983-5517
Mailing address:
  • Phone: 586-983-5687
  • Fax: 586-983-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001013
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS BALL JR.
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 586-983-5687