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General NPI Number Information
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NPI Number | 1043263007
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Entity Type | Organization
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Legal Business Name | ROCK RIVER FOOT & ANKLE CLINIC, SC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 101 OAKRIDGE CT STE A
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City | WATERTOWN
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State | WI
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Zip | 53094-4150
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Country | US
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Telephone | 920-261-9610
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Fax | 920-261-9671
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 920-261-9610
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Fax | 920-261-9671
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. VICTOR STEPHEN SODERSTROM
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Credential | DPM
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Telephone | 920-261-9610
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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