Provider Demographics
NPI:1447317136
Name:FAMILY FOOT AND ANKLE CENTER, P.C.
Entity type:Organization
Organization Name:FAMILY FOOT AND ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SHINK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-667-4663
Mailing Address - Street 1:3801 WILDER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2301
Mailing Address - Country:US
Mailing Address - Phone:989-667-4663
Mailing Address - Fax:989-667-1964
Practice Address - Street 1:312 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1128
Practice Address - Country:US
Practice Address - Phone:989-667-4663
Practice Address - Fax:989-667-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M22980Medicare PIN
MI1131440002Medicare NSC