Healthcare Provider Details

I. General information

NPI: 1689717555
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: 02/14/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 EAST PARIS AVE SE STE 100
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

2144 EAST PARIS AVE SE STE 100
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-0294
  • Fax: 616-726-1492
Mailing address:
  • Phone: 616-281-0666
  • Fax: 616-281-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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