Organization Name: | ANKLE & FOOT ASSOCIATES OF NORTHERN MICHIGAN PC |
NPI Number: | 1003943861 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN M BRAUSA (CO-PRESIDENT) |
Mailing Address: | 408 Lake St Roscommon |
State: | MI US |
Postal Code: | 486537663 |
Phone Number: | 9892753668 |
Fax Number: | |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 11/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 5901002144 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |