Organization
ALLEN PARK FOOTCARE SPECIALIST PLLC
Active
Other names
Brian E. Homer
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN E HOMER D.P.M, P.C. (OWNER)
(248) 288-8900
Entity
Organization
Contact information
Practice address
19250 ECORSE RD, ALLEN PARK, MI 48101-2260
(313) 294-9700
(313) 294-9700
Mailing address
19250 ECORSE RD, ALLEN PARK, MI 48101-2260
(313) 294-9700
(313) 294-9700
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
5901001699
MI
332B00000X
Durable Medical Equipment & Medical Supplies
5901001699
MI
335E00000X
Prosthetic/Orthotic Supplier
5901001699
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H20650
BCBSMI DME
MI
01
—
0H218370
BCBSMI
MI
05
—
133153308
—
MI
01
—
4319060001
MEDICARE DME
MI
01
—
P00102057
RAILROAD MEDICARE
MI
Enumeration date
09/20/2006
Last updated
11/09/2011
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