Healthcare Provider Details

I. General information

NPI: 1770540957
Provider Name (Legal Business Name): GRAND RAPIDS FOOT & ANKLES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W APPLE ST
HASTINGS MI
49058-1810
US

IV. Provider business mailing address

4310 LEONARD ST NW SUITE 103
WALKER MI
49534-8447
US

V. Phone/Fax

Practice location:
  • Phone: 269-945-2606
  • Fax: 269-945-5122
Mailing address:
  • Phone: 616-453-6329
  • Fax: 616-453-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001839
License Number StateMI

VIII. Authorized Official

Name: STEVEN F CHALLA
Title or Position: PHYSICIAN
Credential: DPM
Phone: 269-945-2606