Provider Demographics
NPI:1235116872
Name:ALPINE FAMILY PODIATRY PC
Entity Type:Organization
Organization Name:ALPINE FAMILY PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-785-8707
Mailing Address - Street 1:1773 WOODSIDE TRL NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2580
Mailing Address - Country:US
Mailing Address - Phone:616-453-1835
Mailing Address - Fax:
Practice Address - Street 1:680 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8218
Practice Address - Country:US
Practice Address - Phone:616-785-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-24
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2696228Medicaid
MI2696228Medicaid
MI5415005Medicare ID - Type Unspecified
MI0P48160Medicare PIN
MI0476010001Medicare NSC