Healthcare Provider Details

I. General information

NPI: 1497822712
Provider Name (Legal Business Name): FEET FIRST P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD S-1175
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD S-1175
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-624-8338
  • Fax: 248-926-9498
Mailing address:
  • Phone: 248-624-8338
  • Fax: 248-926-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN MADY
Title or Position: PRESIDENT
Credential:
Phone: 248-624-8338