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General NPI Number Information
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NPI Number | 1063515526
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT CLINIC, SC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 21 S MARR ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4334
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Country | US
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Telephone | 920-921-1669
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Fax | 920-921-7950
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Provider Business Mailing Address
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Address Line | 21 S MARR ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4334
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Country | US
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Telephone | 920-921-1669
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Fax | 920-921-7950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IAN CHARLES FURNESS
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Credential | DPM
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Telephone | 920-921-1669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | WI
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