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General NPI Number Information
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NPI Number | 1568177822
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 388 GARDEN AVE STE 120
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City | HOLLAND
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State | MI
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Zip | 49424-8999
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Country | US
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Telephone | 616-393-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 2144 E PARIS AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6117
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Country | US
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Telephone | 616-281-0666
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Fax | 616-281-0752
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Authorized Official
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Title or Position | EXECUTIVE CHAIRMAN
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Name | LOWELL WEIL JR.
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Credential | DPM
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Telephone | 847-390-7666
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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