Provider Demographics
NPI:1114755634
Name:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Entity type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-390-7666
Mailing Address - Street 1:2144 E PARIS AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6117
Mailing Address - Country:US
Mailing Address - Phone:616-281-0666
Mailing Address - Fax:224-220-9345
Practice Address - Street 1:501 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8036
Practice Address - Country:US
Practice Address - Phone:231-652-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty