Healthcare Provider Details

I. General information

NPI: 1881615938
Provider Name (Legal Business Name): ULTIMATE FOOT COMFORT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 MILTON AVE
JANESVILLE WI
53545-0441
US

IV. Provider business mailing address

2557 MILTON AVE
JANESVILLE WI
53545-0441
US

V. Phone/Fax

Practice location:
  • Phone: 608-741-3338
  • Fax: 608-741-3382
Mailing address:
  • Phone: 608-741-3338
  • Fax: 608-741-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID A SIKER
Title or Position: OWNER
Credential:
Phone: 608-741-3338