MEDICARE: GRANDVIEW FOOT AND ANKLE PC

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	SU001970	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

General Provider Information

NPI Number	:	1114064185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDVIEW FOOT AND ANKLE PC

Provider Business Mailing Address
First Line	:	PO BOX 362
Second Line	:
City	:	HASTINGS
State	:	MI
Zip	:	49058-0362
Country	:	US
Telephone Number	:	269-948-9155
Fax Number	:	269-948-9577

Provider Business Practice Location Address
First Line	:	423 E MAIN ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-9741
Country	:	US
Telephone Number	:	989-584-3916
Fax Number	:	989-584-3917

Authorized Official
Title or Position	:	PODIATRIST
Name	:	STACY AARON UEBELE
Credential	:	DPM
Telephone Number	:	269-948-9155

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/10/2007

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Directions to “GRANDVIEW FOOT AND ANKLE PC ” Practice Location

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