Provider Demographics
NPI:1629113618
Name:ROYALTON FOOT AND ANKLE ASSOC
Entity Type:Organization
Organization Name:ROYALTON FOOT AND ANKLE ASSOC
Other - Org Name:CRAIG OKONSKI, D.P.M.
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:OKONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-428-2440
Mailing Address - Street 1:3800 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8510
Mailing Address - Country:US
Mailing Address - Phone:269-428-2440
Mailing Address - Fax:269-428-0980
Practice Address - Street 1:3800 HOLLYWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8510
Practice Address - Country:US
Practice Address - Phone:269-428-2440
Practice Address - Fax:269-428-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICO001158332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M0903001Medicare ID - Type Unspecified
MIT97179Medicare UPIN