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General NPI Number Information
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NPI Number | 1053914481
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Entity Type | Organization
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Legal Business Name | ANKLE & FOOT ASSOCIATES OF NORTHERN MICHIGAN PC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 5213 W HOUGHTON LAKE DR
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-8214
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Country | US
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Telephone | 989-275-3668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 949
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City | ROSCOMMON
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State | MI
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Zip | 48653-0949
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Country | US
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Telephone | 989-275-3668
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Fax | 989-275-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN M BRAUSA
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Credential | DPM
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Telephone | 989-275-3668
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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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