Provider Demographics
NPI:1144207788
Name:ROTTSCHAFER, WALTER C (DPM)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:C
Last Name:ROTTSCHAFER
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 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:300 S STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1676
Practice Address - Country:US
Practice Address - Phone:616-772-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-24
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWR000763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2105351Medicaid
MI2105351Medicaid
MI0228190001Medicare NSC
MI0985710001Medicare NSC
MIT34253Medicare UPIN
MI5705511Medicare ID - Type Unspecified