Provider Demographics
NPI:1790714277
Name:DAVID, MICHAEL GEORGE (DPM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:DAVID
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:2144 E. PARIS AVE. SE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-281-0666
Mailing Address - Fax:616-281-0752
Practice Address - Street 1:2144 EAST PARIS AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-281-0666
Practice Address - Fax:616-281-0752
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001218213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480026386OtherRAILROAD MEDICARE
MI3506810Medicaid
MI1266510003OtherADMINISTAR
MI3506810Medicaid
MI1266510003OtherADMINISTAR