Provider Demographics
NPI:1033150818
Name:BIG RAPIDS FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:BIG RAPIDS FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:231-796-4522
Mailing Address - Street 1:103 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1745
Mailing Address - Country:US
Mailing Address - Phone:231-796-4522
Mailing Address - Fax:231-796-9516
Practice Address - Street 1:103 S STATE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1745
Practice Address - Country:US
Practice Address - Phone:231-796-9516
Practice Address - Fax:231-796-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4423471Medicaid
MI4667100001Medicare NSC
MI0N55580Medicare PIN
MIU92049Medicare UPIN