Healthcare Provider Details

I. General information

NPI: 1336281542
Provider Name (Legal Business Name): SHORELINE FOOT & ANKLE ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 SEMINOLE RD
NORTON SHORES 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 Number
License Number State

VIII. Authorized Official

Name: DR. ROGER DEYOUNG
Title or Position: OWNER
Credential: D.P.M.
Phone: 231-733-1111