Provider Demographics
NPI:1346654803
Name:THENN, COURTNEY (DPM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:THENN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2461
Mailing Address - Country:US
Mailing Address - Phone:616-685-1200
Mailing Address - Fax:616-685-1211
Practice Address - Street 1:3380 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2461
Practice Address - Country:US
Practice Address - Phone:616-685-1200
Practice Address - Fax:616-685-1211
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002545213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty