Healthcare Provider Details

I. General information

NPI: 1477519791
Provider Name (Legal Business Name): TRAVIS D. PIPER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 SEMINOLE RD
MUSKEGON MI
49444-3719
US

IV. Provider business mailing address

561 SEMINOLE RD
MUSKEGON MI
49444-3719
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1111
  • Fax: 231-733-1144
Mailing address:
  • Phone: 231-733-1111
  • Fax: 231-733-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: