Provider Demographics
NPI:1689729329
Name:ADVANCED FOOT AND ANKLE ASSOCIATES, PC
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE ASSOCIATES, PC
Other - Org Name:ADVANCED FOOT AND ANKLE ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-690-0926
Mailing Address - Street 1:1621 44TH ST SW
Mailing Address - Street 2:SUITE 500
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
Practice Address - Street 2:SUITE 500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0985710001Medicare NSC