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General NPI Number Information
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NPI Number | 1063445237
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Entity Type | Organization
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Legal Business Name | GREAT LAKES FOOT & ANKLE INSTITUTE PLLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/17/2025
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Provider Practice Location Address
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Address Line | 32743 23 MILE RD STE 110
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City | CHESTERFIELD
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State | MI
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Zip | 48047-2082
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Country | US
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Telephone | 586-725-3444
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Fax | 586-725-0984
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Provider Business Mailing Address
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Address Line | 9400 S CICERO AVE STE 100
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City | OAK LAWN
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State | IL
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Zip | 60453-2536
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Country | US
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Telephone | 708-424-3201
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Fax | 708-424-5001
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN FRASCONE
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Credential | DPM
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Telephone | 586-725-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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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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