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General NPI Number Information
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NPI Number | 1326009325
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD FAMILY FOOT CENTER, P.C.
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 17422 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2951
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Country | US
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Telephone | 248-557-2400
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Fax | 248-557-5533
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Provider Business Mailing Address
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Address Line | 17422 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2951
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Country | US
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Telephone | 248-557-2400
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Fax | 248-557-5533
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE B RICHARD
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Credential | D.P.M.
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Telephone | 248-557-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001176
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License Number State | MI
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