Provider Demographics
NPI:1245849009
Name:SOUTHERN MICHIGAN FOOT & ANKLE, PLC
Entity type:Organization
Organization Name:SOUTHERN MICHIGAN FOOT & ANKLE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-485-9748
Mailing Address - Street 1:14167 C B MACDONALD WAY
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-8397
Mailing Address - Country:US
Mailing Address - Phone:616-485-9748
Mailing Address - Fax:
Practice Address - Street 1:14167 C B MACDONALD WAY
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-8397
Practice Address - Country:US
Practice Address - Phone:616-485-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric