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General NPI Number Information
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NPI Number | 1356441695
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC OF WEST MICHIGAN,PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 333 N JEBAVY DR
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City | LUDINGTON
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State | MI
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Zip | 49431-1923
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Country | US
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Telephone | 231-843-2690
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Fax | 231-843-4338
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Provider Business Mailing Address
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Address Line | 333 N JEBAVY DR
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City | LUDINGTON
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State | MI
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Zip | 49431-1923
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Country | US
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Telephone | 231-843-2690
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Fax | 231-843-4338
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN L MAST
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Credential | DPM
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Telephone | 231-843-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001496
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License Number State | MI
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