Healthcare Provider Details

I. General information

NPI: 1558531152
Provider Name (Legal Business Name): NORTH AVENUE PODIATRY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NORTH AVE
BATTLE CREEK MI
49017-3430
US

IV. Provider business mailing address

213 NORTH AVE
BATTLE CREEK MI
49017-3430
US

V. Phone/Fax

Practice location:
  • Phone: 269-968-6000
  • Fax: 269-968-3015
Mailing address:
  • Phone: 269-968-6000
  • Fax: 269-968-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CLARK PETER JOHNSON
Title or Position: PRESIDENT
Credential: DPM
Phone: 269-968-6000