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General NPI Number Information
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NPI Number | 1740571686
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Entity Type | Individual
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Provider Name | MICHAEL EMILEY D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 1238 FULLER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5533
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Country | US
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Telephone | 616-452-0467
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Fax |
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Provider Business Mailing Address
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Address Line | 1238 FULLER AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | NA
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License Number State | MI
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