Provider Demographics
NPI:1780763870
Name:KALAMAZOO FOOT SURGERY, P.C.
Entity type:Organization
Organization Name:KALAMAZOO FOOT SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-344-0874
Mailing Address - Street 1:1212 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5600
Mailing Address - Country:US
Mailing Address - Phone:269-344-0874
Mailing Address - Fax:269-344-7256
Practice Address - Street 1:1212 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-5600
Practice Address - Country:US
Practice Address - Phone:269-344-0874
Practice Address - Fax:269-344-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480C97640OtherBLUE CARE NETWORK
MI0432570002OtherDME
MI480C97640OtherBLUE CROSS BLUE SHIELD
MI0N79480Medicare PIN