Healthcare Provider Details

I. General information

NPI: 1417934050
Provider Name (Legal Business Name): HOLLAND FOOT AND ANKLE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2005
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S WASHINGTON AVE
HOLLAND MI
49423-7724
US

IV. Provider business mailing address

904 WASHINGTON AVE
HOLLAND MI
49423-7724
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-7472
  • Fax: 616-392-3327
Mailing address:
  • Phone: 616-392-7472
  • Fax: 616-392-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MATT J LAPPENGA
Title or Position: PRESIDENT
Credential: DPM
Phone: 616-392-7472