MEDICARE: ALPINE FAMILY PODIATRY 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

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	:	1235116872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE FAMILY PODIATRY PC

Provider Business Mailing Address
First Line	:	1773 WOODSIDE TRL NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2580
Country	:	US
Telephone Number	:	616-453-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 3 MILE RD NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-8218
Country	:	US
Telephone Number	:	616-785-8707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL G MEYERS
Credential	:	DPM
Telephone Number	:	616-785-8707

Provider Enumeration Date	:	12/24/2005
Last Update Date	:	12/07/2007

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