Individual
CORWYN B BERGSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1195 WILSON AVE NW, SUITE 200, GRAND RAPIDS, MI 49534-6405
(616) 453-8277
(616) 453-2002
Mailing address
4540 KALAMAZOO AVE SE, KENTWOOD, MI 49508-4625
(616) 281-0666
(616) 281-0752
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002157
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1266510001
ADMINISTAR
MI
05
—
4584211
—
MI
01
—
480026386
RAILROAD MEDICARE
MI
Enumeration date
07/05/2006
Last updated
12/27/2021
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