Provider Demographics
NPI:1447684972
Name:DR MARTINS FOOT AND ANKLE CLINIC
Entity type:Organization
Organization Name:DR MARTINS FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-879-4241
Mailing Address - Street 1:1325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1721
Mailing Address - Country:US
Mailing Address - Phone:517-879-4242
Mailing Address - Fax:517-879-4240
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1721
Practice Address - Country:US
Practice Address - Phone:517-879-4242
Practice Address - Fax:517-879-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6922750001Medicare NSC