Healthcare Provider Details

I. General information

NPI: 1992986657
Provider Name (Legal Business Name): FOOTSPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11885 E 12 MILE RD SUITE 202 B
WARREN MI
48093-3474
US

IV. Provider business mailing address

21111 MIDDLEBELT RD
FARMINGTON MI
48336
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-4242
  • Fax: 586-755-6231
Mailing address:
  • Phone: 248-478-1150
  • Fax: 248-478-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000671
License Number StateMI

VIII. Authorized Official

Name: DR. MARSHALL GREGORY SOLOMON
Title or Position: OWNER
Credential: DPM
Phone: 586-755-4242