Healthcare Provider Details

I. General information

NPI: 1891832598
Provider Name (Legal Business Name): GRANDVIEW FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 E WASHINGTON ST
GREENVILLE MI
48838-2463
US

IV. Provider business mailing address

PO BOX 362
HASTINGS MI
49058-0362
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-7440
  • Fax: 616-754-0885
Mailing address:
  • Phone: 269-948-9155
  • Fax: 269-948-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSU001970
License Number StateMI

VIII. Authorized Official

Name: STACY AARON UEBELE
Title or Position: PODIATRIST
Credential: DPM
Phone: 269-948-9155