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General NPI Number Information
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NPI Number | 1851563233
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Entity Type | Organization
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Legal Business Name | MARTIN J FAASSE DPM, PC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 3550 FAIRLANES AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1572
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Country | US
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Telephone | 616-534-3920
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Fax | 616-534-0801
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Provider Business Mailing Address
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Address Line | PO BOX 164
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City | GRANDVILLE
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State | MI
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Zip | 49468-0164
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Country | US
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Telephone | 616-534-3920
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Fax | 616-534-0801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN J FAASSE
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Credential | DPM
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Telephone | 616-534-3920
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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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