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General NPI Number Information
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NPI Number | 1578535019
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Entity Type | Organization
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Legal Business Name | ELDER FOOT CARE, PC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 7001 ORCHARD LAKE RD SUITE 230B
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3604
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Country | US
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Telephone | 248-855-3232
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Fax | 248-855-3338
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Provider Business Mailing Address
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Address Line | 7001 ORCHARD LAKE RD SUITE 230B
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3604
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Country | US
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Telephone | 248-855-3232
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Fax | 248-855-3338
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MITCHELL S WAYNE
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Credential | DPM
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Telephone | 248-855-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 5901400097
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License Number State | MI
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