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General NPI Number Information
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NPI Number | 1003124140
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Entity Type | Organization
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Legal Business Name | SHORES FOOT AND ANKLE CENTER LTD.
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 22719 GARFIELD ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1857
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Country | US
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Telephone | 586-294-7250
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Fax | 586-294-7251
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Provider Business Mailing Address
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Address Line | 22719 GARFIELD ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1857
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Country | US
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Telephone | 586-484-7277
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYMOND J FARRAR
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Credential | D.P.M.
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Telephone | 586-484-7277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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