MEDICARE: GREENVILLE FAMILY FOOT CARE P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901001690	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5591031	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1083945281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE FAMILY FOOT CARE P C

Provider Business Mailing Address
First Line	:	917 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1129
Country	:	US
Telephone Number	:	616-754-9580
Fax Number	:	616-754-9519

Provider Business Practice Location Address
First Line	:	917 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1129
Country	:	US
Telephone Number	:	616-754-9580
Fax Number	:	616-754-9519

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANK PAUL WEBBER
Credential	:	DPM
Telephone Number	:	616-754-9580

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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