Provider Demographics
NPI:1659309060
Name:DEWITT, JAMES E (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DEWITT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 44TH ST SW STE 500
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-7200
Mailing Address - Country:US
Mailing Address - Phone:616-538-4442
Mailing Address - Fax:616-538-4843
Practice Address - Street 1:1621 44TH ST SW STE 500
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-7200
Practice Address - Country:US
Practice Address - Phone:616-538-4442
Practice Address - Fax:616-538-4843
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJD001490213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP65453OtherBLUE CARE NETWORK
MI2870966Medicaid
MI5415013OtherBLUE SHIELD PROVIDER
MIU26769Medicare UPIN
MI5415013OtherBLUE SHIELD PROVIDER