Provider Demographics
NPI:1104046325
Name:NORTHWOOD FOOT AND ANKLE CENTER, PC
Entity type:Organization
Organization Name:NORTHWOOD FOOT AND ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-393-8886
Mailing Address - Street 1:388 GARDEN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8999
Mailing Address - Country:US
Mailing Address - Phone:616-393-8886
Mailing Address - Fax:616-393-9975
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8998
Practice Address - Country:US
Practice Address - Phone:616-393-8886
Practice Address - Fax:616-393-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001739332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480029237OtherMEDICARE RAILROAD
MI3516763Medicaid
MI4857010700OtherBLUE CROSS
MI480029237OtherMEDICARE RAILROAD
MI6298790001Medicare NSC