Provider Demographics
NPI:1154460962
Name:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Entity Type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Other - Org Name:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-390-7666
Mailing Address - Street 1:2144 EAST PARIS AVENUE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-281-0666
Mailing Address - Fax:616-281-0752
Practice Address - Street 1:2144 E PARIS SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-281-0666
Practice Address - Fax:616-281-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC12964OtherRAILROAD MEDICARE
MI0D11112OtherBLUE CROSS BLUE SHIELD
MI0D11112OtherBLUE CROSS BLUE SHIELD
1266510002Medicare NSC
1266510003Medicare NSC
MIC12964OtherRAILROAD MEDICARE
1266510001Medicare NSC