Healthcare Provider Details

I. General information

NPI: 1457611170
Provider Name (Legal Business Name): URBAN FOOT CARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9A LAGRANDE PRINCESSE PLAZA SUITE 4
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

3915 W CAPITOL DR
MILWAUKEE WI
53216-2528
US

V. Phone/Fax

Practice location:
  • Phone: 414-793-3211
  • Fax:
Mailing address:
  • Phone: 414-793-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1205
License Number StateVI

VIII. Authorized Official

Name: REGINA FLIPPIN
Title or Position: OWNER
Credential: DPM
Phone: 414-793-3211