Sole Source LLC Your Diabetic Shoe Store

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

SOLE SOURCE LLC YOUR DIABETIC SHOE STORE

Practice address

50 N Huron St
Ypsilanti, MI 48197-2608

Phone

(734) 340-9614

Fax

(734) 879-2774

NPI assigned

Apr 5, 2012

Last updated

May 22, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Annette BottumNPI 1427320787

Title

Shoe Fitter

Phone

(734) 340-9614

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Annette B Bottum

  • Orthotic Fitter
  • Ypsilanti, MI
  • NPI 1427320787
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1063778884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N HURON ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972608",
            "telephone_number": "734-340-9614",
            "fax_number": "734-879-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N HURON ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972608",
            "telephone_number": "734-340-9614",
            "fax_number": "734-879-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLE SOURCE LLC YOUR DIABETIC SHOE STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "BOTTUM",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "SHOE FITTER",
        "authorized_official_telephone_number": "734-340-9614"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Sohrabi
• Melissa Sokol-Keith, M.D.
• Jered Dion Solace
• Anne Marie Solari, LMSW
• Solas Counseling PLLC
• Michael Hugh Solomon, M.D.
• Divya Somuri
• Benjamin J Song, MD
• Rachel S Song, DO
• Robin T. Songer-Cook, L.L.P.

• Prosthetic/Orthotic Supplier in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Prosthetic/Orthotic Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.