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General NPI Number Information
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NPI Number | 1144308321
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC LLP
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 201 CEDAR FALLS RD
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City | MENOMONIE
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State | WI
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Zip | 54751-1270
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Country | US
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Telephone | 715-235-4274
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Fax | 715-235-9644
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | MENOMONIE
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State | WI
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Zip | 54751-0392
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Country | US
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Telephone | 715-235-4274
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Fax | 715-235-9644
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Authorized Official
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Title or Position | MANAGER
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Name | VICKI MACK
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Credential |
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Telephone | 715-235-4274
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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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