1578535019 NPI number — ELDER FOOT CARE, PC

Table of content: (NPI 1578535019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578535019 NPI number — ELDER FOOT CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELDER FOOT CARE, 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:
1578535019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 230B
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-855-3232
Provider Business Practice Location Address Fax Number:
248-855-3338
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAYNE
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
248-855-3232

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  5901400097 , 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)

  • Identifier: CJ9120 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F31907 . This is a "BCBS MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DA4202 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTH ALLIANCE PLAN . This is a "50036704" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0993429 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F31907 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7556372 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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