Healthcare Provider Details

I. General information

NPI: 1316994924
Provider Name (Legal Business Name): AFFILIATED PODIATRISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 S 27TH ST SUITE 101
MILWAUKEE WI
53221-1855
US

IV. Provider business mailing address

4220 S 27TH ST SUITE 101
MILWAUKEE WI
53221-1855
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-5480
  • Fax: 414-281-9866
Mailing address:
  • Phone: 414-281-5480
  • Fax: 414-281-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number372-025
License Number StateWI

VIII. Authorized Official

Name: DR. LOUIS ROBERT LAPOW
Title or Position: PRESIDENT
Credential: DPM
Phone: 414-281-5480