Organization
SOUTH LYON FOOT & ANKLE SPECIALISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY MASTROGIOCOMO DPM (OWNER/PRESIDENT/PODIATRIST)
(248) 486-8886
Entity
Organization
Contact information
Practice address
22245 PONTIAC TRL, SOUTH LYON, MI 48178-1639
(248) 486-8886
(248) 486-8887
Mailing address
22245 PONTIAC TRL, SOUTH LYON, MI 48178-1639
(248) 486-8886
(248) 486-8887
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4856311830
BCBS
MI
Enumeration date
08/29/2005
Last updated
07/21/2022
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