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General NPI Number Information
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NPI Number | 1194922559
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Entity Type | Organization
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Legal Business Name | MICHIGAN FOOT & ANKLE SURGEONS, P.C.
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 29201 TELEGRAPH RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-355-4000
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Fax | 248-355-4047
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Provider Business Mailing Address
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Address Line | 29201 TELEGRAPH RD SUITE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-355-4000
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Fax | 248-355-4047
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARNIE LOUISE HARRIS
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Credential |
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Telephone | 248-355-4000
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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 | RL002077
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | FL000635
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License Number State | MI
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