Healthcare Provider Details

I. General information

NPI: 1588932446
Provider Name (Legal Business Name): MARSHFIELD PODIATRY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S CHESTNUT AVE
MARSHFIELD WI
54449-3605
US

IV. Provider business mailing address

503 S CHESTNUT AVE
MARSHFIELD WI
54449-3605
US

V. Phone/Fax

Practice location:
  • Phone: 715-384-3323
  • Fax: 715-389-2532
Mailing address:
  • Phone: 715-384-3323
  • Fax: 715-389-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number52325
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number52325
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number52325
License Number StateWI

VIII. Authorized Official

Name: DR. GARRY M MARTIN
Title or Position: OWNER
Credential: DPM
Phone: 715-384-3323