Healthcare Provider Details

I. General information

NPI: 1356372866
Provider Name (Legal Business Name): R FLIPPIN SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 W CAPITOL DR
MILWAUKEE WI
53216-2528
US

IV. Provider business mailing address

PO BOX 16557
MILWAUKEE WI
53216-0557
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-9242
  • Fax: 414-444-9252
Mailing address:
  • Phone: 414-444-9242
  • Fax: 414-444-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: REGINA FLIPPIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 414-444-9242