Healthcare Provider Details

I. General information

NPI: 1689729329
Provider Name (Legal Business Name): ADVANCED FOOT AND ANKLE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 44TH ST SW SUITE 500
WYOMING MI
49509-7200
US

IV. Provider business mailing address

1621 44TH ST SW SUITE 500
WYOMING MI
49509-7200
US

V. Phone/Fax

Practice location:
  • Phone: 616-538-4442
  • Fax: 616-538-4843
Mailing address:
  • Phone: 616-538-4442
  • Fax: 616-538-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HARTGER
Title or Position: OWNER
Credential: DPM
Phone: 616-690-0926