Provider Demographics
NPI:1962489500
Name:WALTER C ROTTSCHAFER DPM PC
Entity Type:Organization
Organization Name:WALTER C ROTTSCHAFER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROTTSCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-772-1070
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:300 S STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1676
Practice Address - Country:US
Practice Address - Phone:616-772-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-24
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2105351Medicaid
MI6156660001Medicare NSC
MI0P58170Medicare PIN
MIT34253Medicare UPIN
MI0228190001Medicare NSC
MI2105351Medicaid