Great Lakes Foot & Ankle Institute PC – Foot & Ankle Surgery Podiatrist, NPI 1063445237
Foot & Ankle Surgery Podiatrist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Great Lakes Foot & Ankle Institute PC
14555 LeVan Rd Ste E302
Livonia, MI 481545042
Phone: (734) 591-6612
Fax: (734) 591-6625
Type: Location
29201 Telegraph Rd Ste 100
Southfield, MI 480347630
Phone: (248) 353-9300
Fax: (248) 353-9303
Type: Location
13350 24 Mile Rd Ste 600
Shelby Twp, MI 483151827
Phone: (586) 725-3444
Type: Location
1135 W University Dr Ste 305
Rochester, MI 483071892
Phone: (586) 725-3444
Type: Location
43900 Garfield Rd Ste 140
Clinton Twp, MI 480381137
Phone: (586) 725-3444
Type: Location
4190 24th Ave Ste 102
Fort Gratiot, MI 480593883
Phone: (586) 725-3444
Type: Location
32743 23 MILE RD STE 110
CHESTERFIELD, MI 480472082
Phone: (586) 725-3444
Fax: (586) 725-0984
Type: Location
9400 S CICERO AVE STE 100
OAK LAWN, IL 604532536
Phone: (708) 424-3201
Fax: (708) 424-5001
Type: Mailing
23 Mile Road, Chesterfield Township, Macomb County, Michigan, 48047, United States
STE 210
CHESTERFIELD, MI 480471985
Phone: (586) 725-3444
Fax: (586) 725-0984
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-11-30 (193 days ago).
Enrollment records
2
Earliest due date
2025-11-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20041028000887 | O | Clinic/Group Practice | MI | TBD |
| O20100930089489 | O | Physician - Podiatry | MI | 2025-11-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48154)
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