Provider Demographics
NPI:1083945281
Name:GREENVILLE FAMILY FOOT CARE P C
Entity Type:Organization
Organization Name:GREENVILLE FAMILY FOOT CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-754-9580
Mailing Address - Street 1:917 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1129
Mailing Address - Country:US
Mailing Address - Phone:616-754-9580
Mailing Address - Fax:616-754-9519
Practice Address - Street 1:917 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1129
Practice Address - Country:US
Practice Address - Phone:616-754-9580
Practice Address - Fax:616-754-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001690213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI132955099Medicaid
MI5591031OtherBCBSM
MI5595788Medicare PIN
MIT87207Medicare UPIN