Healthcare Provider Details

I. General information

NPI: 1457493389
Provider Name (Legal Business Name): ROCK RIVER FOOT & ANKLE CLINIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 HAKE ST
FORT ATKINSON WI
53538-1212
US

IV. Provider business mailing address

101 OAKRIDGE CT STE A
WATERTOWN WI
53094-4150
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-2136
  • Fax: 920-563-3673
Mailing address:
  • Phone: 920-261-9610
  • Fax: 920-261-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL TRITTO
Title or Position: OWNER
Credential:
Phone: 301-933-7133