Provider Demographics
NPI:1477690428
Name:GRANDVIEW FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:GRANDVIEW FOOT AND ANKLE PC
Other - Org Name:STACY A UEBELE DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:UEBELE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-948-9155
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-0362
Mailing Address - Country:US
Mailing Address - Phone:269-948-9155
Mailing Address - Fax:269-948-9577
Practice Address - Street 1:231 W PINE LAKE DR
Practice Address - Street 2:SUITE NUMBER 102
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8028
Practice Address - Country:US
Practice Address - Phone:231-652-5955
Practice Address - Fax:231-652-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISU001970213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4710219Medicaid
MIP02180001Medicare ID - Type Unspecified
MIU86206Medicare UPIN
MI5850020002Medicare NSC