Healthcare Provider Details

I. General information

NPI: 1124182456
Provider Name (Legal Business Name): NORTHFIELD PODIATRY ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49505-3700
US

IV. Provider business mailing address

2501 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49505-3700
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-8495
  • Fax: 616-364-1955
Mailing address:
  • Phone: 616-364-8495
  • Fax: 616-364-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number5901001390
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001390
License Number StateMI

VIII. Authorized Official

Name: MARTIN G HOFFMEISTER
Title or Position: VICE PRESIDENT
Credential: D.P.M.
Phone: 616-364-8495