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General NPI Number Information
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NPI Number | 1851846257
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Entity Type | Organization
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Legal Business Name | PREMIER FOOT & ANKLE PLLC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 17900 23 MILE RD SUITE 204
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City | MACOMB
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State | MI
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Zip | 48044-1161
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Country | US
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Telephone | 586-557-7233
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 380984
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City | CLINTON TWP
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State | MI
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Zip | 48038-0074
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Country | US
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Telephone | 586-557-7233
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. STEFANO MILITELLO
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Credential | DPM
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Telephone | 586-557-7233
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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 | 5901002316
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License Number State | MI
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