MEDICARE: ELDER FOOT CARE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	5901400097	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9120	OTHER	MI	RAILROAD MEDICARE
3	DA4202	OTHER	MI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0F31907	OTHER	MI	BCBS MICHIGAN
4	HEALTH ALLIANCE PLAN	OTHER	MI	50036704
5	0993429	OTHER	MI	HEALTH PLUS OF MICHIGAN
6	0F31907	OTHER	MI	BLUE CARE NETWORK
7	7556372	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1578535019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDER FOOT CARE, PC

Provider Business Mailing Address
First Line	:	7001 ORCHARD LAKE RD
Second Line	:	SUITE 230B
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3604
Country	:	US
Telephone Number	:	248-855-3232
Fax Number	:	248-855-3338

Provider Business Practice Location Address
First Line	:	7001 ORCHARD LAKE RD
Second Line	:	SUITE 230B
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3604
Country	:	US
Telephone Number	:	248-855-3232
Fax Number	:	248-855-3338

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MITCHELL S WAYNE
Credential	:	DPM
Telephone Number	:	248-855-3232

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	10/04/2007

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Directions to “ELDER FOOT CARE, PC ” Practice Location

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