MEDICARE: MICHIGAN FOOT SURGEONS, P.C.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	RL002077	MI
2	213ES0103X	Foot & Ankle Surgery Podiatrist	FL000635	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1669497327	OTHER	RANDY NPI
2	1528091378	OTHER	FRED NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942491857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN FOOT SURGEONS, P.C.

Provider Business Mailing Address
First Line	:	12720 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1301
Country	:	US
Telephone Number	:	313-863-6888
Fax Number	:	313-863-1687

Provider Business Practice Location Address
First Line	:	12720 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1301
Country	:	US
Telephone Number	:	313-863-6888
Fax Number	:	313-863-1687

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARNIE LOUISE HARRIS
Credential	:
Telephone Number	:	248-355-4000

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/22/2020

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