1619214855 NPI number — FOOT HEALTHCARE ASSOCIATES, PC

Table of content: (NPI 1619214855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619214855 NPI number — FOOT HEALTHCARE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT HEALTHCARE ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619214855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37595 7 MILE RD STE 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-258-0001
Provider Business Mailing Address Fax Number:
248-258-6779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-258-0001
Provider Business Practice Location Address Fax Number:
248-258-6779
Provider Enumeration Date:
01/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOZEN
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
248-258-0001

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  5901001143 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 5901002465 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 5901002233 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 5901002271 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215913694 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1902096902 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5901002465 . This is a "PODIATRIC PHYSICAN & SURGEON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1457593162 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5901001143 . This is a "PODIATRYIC PHYSICIAN & SURGEON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1821253022 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5901002233 . This is a "PODIATRIC PHYSICIAN & SURGEON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0611170003 . This is a "MEDICARE DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5901002271 . This is a "PODIATRIC PHYSICIAN & SURGEON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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