Provider Demographics
NPI:1376638114
Name:TROMPEN, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:TROMPEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:TROMPEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4915 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-942-5061
Mailing Address - Fax:616-942-0612
Practice Address - Street 1:4915 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-942-5061
Practice Address - Fax:616-942-0612
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT001332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3019006Medicaid
T34014Medicare UPIN
MIOP18820002Medicare ID - Type Unspecified