Healthcare Provider Details

I. General information

NPI: 1205155819
Provider Name (Legal Business Name): NATHANIEL J VOSHEL DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 3 MILE RD NW SUITE 100
GRAND RAPIDS MI
49544-8229
US

IV. Provider business mailing address

4310 LEONARD ST NW SUITE 103
GRAND RAPIDS MI
49534-8447
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-1595
  • Fax: 616-784-5920
Mailing address:
  • Phone: 616-453-6329
  • Fax: 616-453-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002260
License Number StateMI

VIII. Authorized Official

Name: DR. NATHANIEL J VOSHEL
Title or Position: PHYSICIAN
Credential: DPM
Phone: 616-784-1595