Organization
CENTER FOR RECONSTRUCTIVE SURGERY OF THE FOOT ANKLE & LEG, PLLC
Active
Other names
Reconstructive Foot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SEHRA SIDDIQUE (MANAGER)
(248) 545-4110
Entity
Organization
Contact information
Practice address
13855 W 9 MILE RD, SUITE C, OAK PARK, MI 48237-2775
(248) 545-4110
(248) 544-2502
Mailing address
13855 W 9 MILE RD, SUITE C, OAK PARK, MI 48237-2775
(248) 545-4110
(248) 544-2502
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002201
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P61440
AETNA
—
05
—
0P61440
—
MI
01
—
4856319350
BCBSM
MI
01
—
6140810001
MEDICARE NGS
MI
Enumeration date
06/05/2008
Last updated
08/04/2012
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