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General NPI Number Information
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NPI Number | 1801910229
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Entity Type | Organization
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Legal Business Name | EAST SIDE FOOT & ANKLE CLINIC PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 22301 GREATER MACK AVE SUITE 3
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2376
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Country | US
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Telephone | 586-776-7000
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Fax | 586-776-7003
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Provider Business Mailing Address
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Address Line | 22301 GREATER MACK AVE SUITE 3
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2376
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Country | US
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Telephone | 586-776-7000
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Fax | 586-776-7003
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID BERLIN
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Credential | D.P.M.
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Telephone | 586-776-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 5901001005
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001005
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License Number State | MI
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