Healthcare Provider Details

I. General information

NPI: 1740571686
Provider Name (Legal Business Name): MICHAEL EMILEY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 FULLER AVE NE
GRAND RAPIDS MI
49505-5533
US

IV. Provider business mailing address

1238 FULLER AVE NE
GRAND RAPIDS MI
49505-5533
US

V. Phone/Fax

Practice location:
  • Phone: 616-452-0467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNA
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: