Healthcare Provider Details

I. General information

NPI: 1568177822
Provider Name (Legal Business Name): FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 GARDEN AVE STE 120
HOLLAND MI
49424-8999
US

IV. Provider business mailing address

2144 E PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-6117
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-8886
  • Fax:
Mailing address:
  • Phone: 616-281-0666
  • Fax: 616-281-0752

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 StateNULL

VIII. Authorized Official

Name: LOWELL WEIL JR.
Title or Position: EXECUTIVE CHAIRMAN
Credential: DPM
Phone: 847-390-7666