Healthcare Provider Details

I. General information

NPI: 1720019250
Provider Name (Legal Business Name): REGINA FLIPPIN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/11/2008
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

3915 W CAPITOL DR
MILWAUKEE WI
53216-2528
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 Number919.25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: