1407564545 NPI number — FOOT HEALTHCARE ASSOCIATES P.C.

Table of content: JAKERIOUS Q. WOLFE (NPI 1912704115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407564545 NPI number — FOOT HEALTHCARE ASSOCIATES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT HEALTHCARE ASSOCIATES P.C.
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:
1407564545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
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:
48152-1489
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:
1225 S LATSON RD STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-7661
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:
11/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FENN
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
248-258-0001

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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