Provider Demographics
NPI:1417934050
Name:HOLLAND FOOT AND ANKLE CENTER PC
Entity Type:Organization
Organization Name:HOLLAND FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAPPENGA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-392-7472
Mailing Address - Street 1:904 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7724
Mailing Address - Country:US
Mailing Address - Phone:616-392-7472
Mailing Address - Fax:616-392-3327
Practice Address - Street 1:904 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7724
Practice Address - Country:US
Practice Address - Phone:616-392-7472
Practice Address - Fax:616-392-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-24
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480Z376040OtherBCBS
MIMO10933OtherCHAMPUS
MI0M15760Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
MI480Z376040OtherBCBS