Healthcare Provider Details

I. General information

NPI: 1396282935
Provider Name (Legal Business Name): HOLLAND FOOT AND ANKLE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 120TH AVE
HOLLAND MI
49424-2119
US

IV. Provider business mailing address

904 WASHINGTON AVE
HOLLAND MI
49423-7724
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-1300
  • Fax: 616-738-0768
Mailing address:
  • Phone: 616-392-7472
  • Fax: 616-392-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENT VAN TIL
Title or Position: OWNER
Credential: DPM
Phone: 616-392-7472