=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417908633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST FOOT & ANKLE SPECIALISTS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 09/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 HOWARD ST
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-385-1000
-----------------------------------------------------
Fax | 269-385-5120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 HOWARD ST
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-385-1000
-----------------------------------------------------
Fax | 269-385-5120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TAMARA M WHITAKER BAY
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 269-385-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | TW002034
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------