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General NPI Number Information
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NPI Number | 1336835875
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE INSTITUTE OF SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1107 STONE ST STE 3
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City | PORT HURON
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State | MI
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Zip | 48060-3569
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Country | US
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Telephone | 810-204-4494
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Fax | 810-479-9640
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Provider Business Mailing Address
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Address Line | 1107 STONE ST STE 3
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City | PORT HURON
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State | MI
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Zip | 48060-3569
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Country | US
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Telephone | 810-204-4494
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Fax | 810-479-9640
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Authorized Official
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Title or Position | COO
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Name | RACHELLE RANDALL
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Credential | DPM
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Telephone | 810-650-7113
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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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