Provider Demographics
NPI:1417155508
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:
Other - Org Type:
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 E PARIS AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6117
Mailing Address - Country:US
Mailing Address - Phone:616-281-0666
Mailing Address - Fax:616-281-0752
Practice Address - Street 1:1195 WILSON NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6404
Practice Address - Country:US
Practice Address - Phone:616-453-8277
Practice Address - Fax:616-453-2002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE SPECIALISTS OF WEST MICHIGAN P L L C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOM71140213ES0103X
MIWD000997332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM71140Medicare PIN
MI1266510001Medicare NSC