Healthcare Provider Details

I. General information

NPI: 1811306434
Provider Name (Legal Business Name): ALLIANCE FOOT & ANKLE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 W LAYTON AVE
GREENFIELD WI
53220-4563
US

IV. Provider business mailing address

6510 W LAYTON AVE
GREENFIELD WI
53220-4563
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-7209
  • Fax: 414-282-9948
Mailing address:
  • Phone: 414-282-7209
  • Fax: 414-282-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1026-25
License Number StateWI

VIII. Authorized Official

Name: DR. IVELISSE VARGAS JON
Title or Position: OWNER
Credential: DPM
Phone: 908-768-8584