MEDICARE: PREMIER FOOT & ANKLE II PLLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1760961577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FOOT & ANKLE II PLLC

Provider Business Mailing Address
First Line	:	17900 23 MILE RD STE 204
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1161
Country	:	US
Telephone Number	:	586-948-9417
Fax Number	:	586-846-3910

Provider Business Practice Location Address
First Line	:	5777 W MAPLE RD STE 170
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4448
Country	:	US
Telephone Number	:	248-847-3288
Fax Number	:	248-847-3275

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY LALAMA
Credential	:	DPM
Telephone Number	:	586-948-9417

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	08/13/2018

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