Healthcare Provider Details

I. General information

NPI: 1104046325
Provider Name (Legal Business Name): NORTHWOOD FOOT AND ANKLE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 GARDEN AVE SUITE 120
HOLLAND MI
49424-8998
US

IV. Provider business mailing address

388 GARDEN AVE SUITE 120
HOLLAND MI
49424-8999
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-8886
  • Fax: 616-393-9975
Mailing address:
  • Phone: 616-393-8886
  • Fax: 616-393-9975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001739
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901001739
License Number StateMI

VIII. Authorized Official

Name: PATRICIA GUISINGER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 616-393-8886