Healthcare Provider Details

I. General information

NPI: 1003341520
Provider Name (Legal Business Name): BALANCED PODIATRY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30205 SCHOENHERR RD STE A
WARREN MI
48088-6800
US

IV. Provider business mailing address

4540 OLD OAK CT
PLYMOUTH MI
48170-6441
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-1288
  • Fax: 586-299-2001
Mailing address:
  • Phone: 586-751-1288
  • Fax: 586-299-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RAMI AL-RASHED
Title or Position: PRESIDENT
Credential: DPM
Phone: 734-474-4324