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General NPI Number Information
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NPI Number | 1568501062
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Entity Type | Organization
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Legal Business Name | DELTA FOOT CARE, P.C.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 04/21/2009
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Provider Practice Location Address
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Address Line | 3802 W KALAMAZOO ST
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City | LANSING
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State | MI
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Zip | 48917-3653
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Country | US
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Telephone | 517-485-7300
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Fax | 517-485-7301
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Provider Business Mailing Address
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Address Line | 3802 W KALAMAZOO ST
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City | LANSING
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State | MI
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Zip | 48917-3653
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Country | US
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Telephone | 517-485-7300
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Fax | 517-485-7301
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN SPENCER GOOSEN
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Credential | DPM
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Telephone | 517-485-7300
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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 | BG001798
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License Number State | MI
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