Healthcare Provider Details

I. General information

NPI: 1447062955
Provider Name (Legal Business Name): FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S STATE ST
BIG RAPIDS MI
49307-1745
US

IV. Provider business mailing address

1660 FEEHANVILLE DR STE 450
MOUNT PROSPECT IL
60056-6023
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-4522
  • Fax: 616-281-0752
Mailing address:
  • Phone: 847-390-7666
  • Fax: 224-220-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LOWELL SCOTT WEIL JR.
Title or Position: EXECUTIVE CHAIRMAN
Credential: DPM
Phone: 847-390-7666