# FOOT & ANKLE INSTITUTE OF SPORTS MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336835875
- **Authorized official:** RACHELLE RANDALL DPM (COO)
- **Authorized official phone:** (810) 650-7113

## Contact information

- **Practice address:** 1107 STONE ST STE 3, PORT HURON, MI 48060-3569
- **Practice address phone:** (810) 204-4494
- **Practice address fax:** (810) 479-9640
- **Mailing address:** 1107 STONE ST STE 3, PORT HURON, MI 48060-3569
- **Mailing address phone:** (810) 204-4494
- **Mailing address fax:** (810) 479-9640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 02/11/2025