Provider Demographics
NPI:1306874961
Name:REWITZER, JEFFREY S (DPM)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:REWITZER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:616-281-0752
Practice Address - Street 1:1450 FARR RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9738
Practice Address - Country:US
Practice Address - Phone:231-739-7606
Practice Address - Fax:231-830-9896
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480033384OtherRAILROAD MEDICARE
MI4362106Medicaid
MI1266510004OtherADMINISTAR
MI0M71140Medicare ID - Type UnspecifiedPROVIDER NO.
MI4362106Medicaid