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General NPI Number Information
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NPI Number | 1336281542
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Entity Type | Organization
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Legal Business Name | SHORELINE FOOT & ANKLE ASSOCIATES P.C.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 561 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3719
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Country | US
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Telephone | 231-733-1111
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Fax | 231-733-1144
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Provider Business Mailing Address
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Address Line | 561 SEMINOLE RD
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City | MUSKEGON
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State | MI
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Zip | 49444-3719
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Country | US
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Telephone | 231-733-1111
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Fax | 231-733-1144
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROGER DEYOUNG
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Credential | D.P.M.
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Telephone | 231-733-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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