MEDICARE: KALAMAZOO 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	TR000730	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	:	1639394851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALAMAZOO 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	:	616-453-1725

Provider Business Practice Location Address
First Line	:	333 TURWILL LN
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5225
Country	:	US
Telephone Number	:	269-373-1019
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	THOMAS D REDMOND
Credential	:	DPM
Telephone Number	:	269-373-1019

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	10/31/2007

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