Organization
COMMUNITY FOOT CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY ALAN WASIAK DPM (PRESIDENT)
(248) 478-6363
Entity
Organization
Contact information
Practice address
31450 7 MILE RD, LIVONIA, MI 48152-1374
(248) 478-6363
(248) 478-9779
Mailing address
2997 E HIGHLAND RD, HIGHLAND, MI 48356-2811
(248) 887-3729
(248) 889-8910
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901000651
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1062554
—
MI
01
—
5825393
BCBS
MI
Enumeration date
08/31/2009
Last updated
08/31/2009
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