Healthcare Provider Details

I. General information

NPI: 1770104994
Provider Name (Legal Business Name): PRECISION PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: FADI JAAFAR
Title or Position: PRESIDENT
Credential: DPM
Phone: 313-203-6002