Healthcare Provider Details

I. General information

NPI: 1407833049
Provider Name (Legal Business Name): CROSWELL PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2005
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 BURTON ST SE SUITE 200
GRAND RAPIDS MI
49546-4800
US

IV. Provider business mailing address

2460 BURTON ST SE SUITE 200
GRAND RAPIDS MI
49546-4800
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-9571
  • Fax:
Mailing address:
  • Phone: 616-774-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES R SOLON III
Title or Position: PRESIDENT
Credential: DPM
Phone: 616-774-9571