Provider Demographics
NPI:1063499630
Name:SOLON, CHARLES R III (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:SOLON
Suffix:III
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 1:2460 BURTON ST SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4800
Mailing Address - Country:US
Mailing Address - Phone:616-774-9571
Mailing Address - Fax:
Practice Address - Street 1:2460 BURTON ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4800
Practice Address - Country:US
Practice Address - Phone:616-774-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS001382213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4376578Medicaid
MIT34015Medicare UPIN
MI0N40150Medicare ID - Type Unspecified
MI5093230001Medicare NSC