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General NPI Number Information
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NPI Number | 1396095246
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Entity Type | Organization
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Legal Business Name | AFFILIATED FOOT & ANKLE CLINIC, P.L.L.C.
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 3930 E 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48234-1012
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Country | US
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Telephone | 313-368-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 E 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48234-1012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONDY GOINS
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Credential | DPM
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Telephone | 313-368-1557
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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 | 5901001535
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License Number State | MI
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