Healthcare Provider Details

I. General information

NPI: 1932265469
Provider Name (Legal Business Name): URBAN FOOT CARE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 W CAPITOL DR #A
MILWAUKEE WI
53216-2528
US

IV. Provider business mailing address

3915 W CAPITOL DR #A
MILWAUKEE WI
53216-2528
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-2936
  • Fax: 414-444-9252
Mailing address:
  • Phone: 414-444-2936
  • Fax: 414-444-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REGINA FLIPPIN
Title or Position: CEO
Credential: DPM
Phone: 312-371-4781