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General NPI Number Information
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NPI Number | 1467625723
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Entity Type | Organization
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Legal Business Name | PODIATRY WEST SENIOR FOOT CARE SERVICES PLLC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 56 BENJAMIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1628
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Country | US
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Telephone | 616-456-9744
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Fax | 616-451-0717
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Provider Business Mailing Address
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Address Line | 56 BENJAMIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1628
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Country | US
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Telephone | 616-456-9744
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Fax | 616-451-0717
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Authorized Official
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Title or Position | GENERAL MEMBER
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Name | DAVID SMITH
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Credential | D.P.M.
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Telephone | 616-456-9744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001622
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License Number State | MI
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