MEDICARE: SOUTHWEST FOOT & ANKLE SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	TW002034	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	480C912300	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1417908633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FOOT & ANKLE SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	515 HOWARD ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-1917
Country	:	US
Telephone Number	:	269-385-1000
Fax Number	:	269-385-5120

Provider Business Practice Location Address
First Line	:	515 HOWARD ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-1917
Country	:	US
Telephone Number	:	269-385-1000
Fax Number	:	269-385-5120

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAMARA M WHITAKER BAY
Credential	:	DPM
Telephone Number	:	269-385-1000

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	09/09/2008

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