MEDICARE: MCIVER FOOT CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699818419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCIVER FOOT CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1466
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53008-1466
Country	:	US
Telephone Number	:	262-788-9229
Fax Number	:	262-788-9241

Provider Business Practice Location Address
First Line	:	7903 WEST CAPITOL DRIVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1903
Country	:	US
Telephone Number	:	414-344-6788
Fax Number	:	414-344-6843

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WARREN K MCIVER
Credential	:	DPM
Telephone Number	:	414-344-6788

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	12/16/2016

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