Organization
GENTLE FOOT CARE OF WESTERN OHIO, INC.
Active
Parent organization
GENTLE FOOT CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENTLE FOOT CARE
Authorized official
CARMEN HENDERSON (CREDENTIALS SPECIALIST)
(614) 457-3212
Entity
Organization
Contact information
Practice address
3800 WOODWARD AVE STE 318, DETROIT, MI 48201-2066
(313) 833-3090
(313) 833-7843
Mailing address
3800 WOODWARD AVE STE 318, SUITE 1102, DETROIT, MI 48201-2066
(313) 833-3090
(313) 833-7843
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
5901002275
MI
332B00000X
Durable Medical Equipment & Medical Supplies
5901002275
MI
335E00000X
Prosthetic/Orthotic Supplier
5901002275
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316191679
MEDICARE NPI
MI
05
—
1316191679
—
MI
01
—
1417136029
MEDICARE NPI
MI
05
—
1417136029
—
MI
01
—
MI1225
MEDICARE PTAN
MI
01
—
MI1225001
MEDICARE PTAN
MI
Enumeration date
04/24/2009
Last updated
11/04/2009
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