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General NPI Number Information
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NPI Number | 1093963456
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Entity Type | Organization
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Legal Business Name | WAUSAU PODIATRY CENTER LTD
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 115 W BRIDGE ST
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City | WAUSAU
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State | WI
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Zip | 54401-2929
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Country | US
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Telephone | 715-842-4288
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Fax | 715-842-2162
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Provider Business Mailing Address
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Address Line | 115 W BRIDGE ST
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City | WAUSAU
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State | WI
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Zip | 54401-2929
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Country | US
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Telephone | 715-842-4288
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Fax | 715-842-2162
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Authorized Official
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Title or Position | PRESIDENT/PODIATRIST
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Name | DR. ANDERS V JUVONEN
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Credential | DMP
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Telephone | 715-842-4288
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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 | 437
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License Number State | WI
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