Healthcare Provider Details

I. General information

NPI: 1699818419
Provider Name (Legal Business Name): MCIVER FOOT CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7903 WEST CAPITOL DRIVE
MILWAUKEE WI
53222-1903
US

IV. Provider business mailing address

PO BOX 1466
BROOKFIELD WI
53008-1466
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-6788
  • Fax: 414-344-6843
Mailing address:
  • Phone: 262-788-9229
  • Fax: 262-788-9241

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: DR. WARREN K MCIVER
Title or Position: OWNER
Credential: DPM
Phone: 414-344-6788