Provider Demographics
NPI:1447455415
Name:FOREST HILLS PODIATRY
Entity type:Organization
Organization Name:FOREST HILLS PODIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYISICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TROMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:616-942-5061
Mailing Address - Street 1:4915 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3722
Mailing Address - Country:US
Mailing Address - Phone:616-942-5061
Mailing Address - Fax:
Practice Address - Street 1:4915 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3722
Practice Address - Country:US
Practice Address - Phone:616-942-5061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT001332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5364370001Medicare NSC
MI0P18820Medicare PIN
MIT34014Medicare UPIN