Healthcare Provider Details

I. General information

NPI: 1083945281
Provider Name (Legal Business Name): GREENVILLE FAMILY FOOT CARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 N LAFAYETTE ST
GREENVILLE MI
48838-1129
US

IV. Provider business mailing address

917 N LAFAYETTE ST
GREENVILLE MI
48838-1129
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-9580
  • Fax: 616-754-9519
Mailing address:
  • Phone: 616-754-9580
  • Fax: 616-754-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001690
License Number StateMI

VIII. Authorized Official

Name: DR. FRANK PAUL WEBBER
Title or Position: OWNER
Credential: DPM
Phone: 616-754-9580