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General NPI Number Information
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NPI Number | 1023204286
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Entity Type | Organization
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Legal Business Name | BEAVER DAM FOOT & ANKLE CENTER, INC.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 301 S ROOSEVELT DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-2439
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Country | US
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Telephone | 920-885-6434
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Fax | 920-885-2640
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Provider Business Mailing Address
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Address Line | 301 S ROOSEVELT DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-2439
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Country | US
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Telephone | 920-885-6434
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Fax | 920-885-2640
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. ROLF HARALD HANSEN
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Credential | DPM
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Telephone | 920-885-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 865
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License Number State | WI
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