Center for Reconstructive Surgery of the Foot Ankle & Leg, PLLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

5901002201 Issued in MI

Legal business name

CENTER FOR RECONSTRUCTIVE SURGERY OF THE FOOT ANKLE & LEG, PLLC

Practice address

13855 W 9 Mile Rd
Suite C
Oak Park, MI 48237-2775

Phone

(248) 545-4110

Fax

(248) 544-2502

NPI assigned

Jun 5, 2008

Organization subpart

No

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

Authorized official

Name

Sehra Siddique

Title

Manager

Phone

(248) 545-4110

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Reconstructive Foot Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shahzad S Qureshi, DPM

  • Foot & Ankle Surgery Podiatrist
  • Farmington Hills, MI
  • NPI 1558588582
  Medicare reassignment NPD

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344038400000",
    "number": "1104085083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13855 W 9 MILE RD",
            "address_2": "SUITE C",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372775",
            "telephone_number": "248-545-4110",
            "fax_number": "248-544-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13855 W 9 MILE RD",
            "address_2": "SUITE C",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372775",
            "telephone_number": "248-545-4110",
            "fax_number": "248-544-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR RECONSTRUCTIVE SURGERY OF THE FOOT ANKLE & LEG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2012-08-04",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "SEHRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-545-4110"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901002201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0P61440",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0P61440",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "4856319350",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NGS",
            "identifier": "6140810001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reconstructive Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Foot & Ankle Surgery Podiatrist in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Foot & Ankle Surgery Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.