Provider Demographics
NPI:1487348413
Name:MA FOOT & ANKLE PLLC
Entity type:Organization
Organization Name:MA FOOT & ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHOMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SAWAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-498-1769
Mailing Address - Street 1:4716 MADA CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2228
Mailing Address - Country:US
Mailing Address - Phone:917-498-1769
Mailing Address - Fax:
Practice Address - Street 1:2035 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:917-498-1769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty