=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215044276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY FOOT CLINIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 12/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 10TH ST
-----------------------------------------------------
City | MENOMINEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49858-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-863-5585
-----------------------------------------------------
Fax | 906-863-8420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4320 10TH ST
-----------------------------------------------------
City | MENOMINEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49858-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-863-5585
-----------------------------------------------------
Fax | 906-863-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID ALAN HAMMER
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 906-863-5585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 5901001935
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------