Healthcare Provider Details

I. General information

NPI: 1457450702
Provider Name (Legal Business Name): MOBILE FOOT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LAKE MEADOW DR
WATERFORD MI
48327-1785
US

IV. Provider business mailing address

PO BOX 337
HARTLAND MI
48353
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-2111
  • Fax: 313-565-0944
Mailing address:
  • Phone: 517-548-4738
  • Fax: 517-548-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001763
License Number StateMI

VIII. Authorized Official

Name: RAJEEV SEHGAL
Title or Position: OWNER
Credential: DPM
Phone: 313-565-2111