Healthcare Provider Details

I. General information

NPI: 1467664904
Provider Name (Legal Business Name): SPARTAN PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH KALAMAZOO AVE.
MARSHALL MI
49068
US

IV. Provider business mailing address

1600 SOUTH KALAMAZOO AVE.
MARSHALL MI
49068
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-4700
  • Fax: 269-781-7168
Mailing address:
  • Phone: 269-781-4700
  • Fax: 269-781-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberWG000970
License Number StateMI

VIII. Authorized Official

Name: DR. ANGELA ROBIN
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 269-781-4700