1104941400 NPI number — CAPITAL FOOT & ANKLE CENTERS, PC

Table of content: (NPI 1104941400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104941400 NPI number — CAPITAL FOOT & ANKLE CENTERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL FOOT & ANKLE CENTERS, 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:
1104941400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2843 E GRAND RIVER AVE
Provider Second Line Business Mailing Address:
#235
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-853-8951
Provider Business Mailing Address Fax Number:
517-913-5996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2270 JOLLY OAK RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-853-8951
Provider Business Practice Location Address Fax Number:
517-913-5996
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-853-8951

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  JG002023 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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