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General NPI Number Information
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NPI Number | 1326299553
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Entity Type | Organization
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Legal Business Name | WISCONSIN FOOT CENTER, LLC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 6130 S 108TH STREET
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City | HALES CORNERS
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State | WI
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Zip | 53130-2525
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Country | US
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Telephone | 414-425-8400
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Fax | 414-425-8425
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Provider Business Mailing Address
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Address Line | 6130 S 108TH STREET
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City | HALES CORNERS
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State | WI
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Zip | 53130-2525
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Country | US
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Telephone | 414-425-8400
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Fax | 414-425-8425
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW J MARSO
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Credential | DPM
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Telephone | 414-425-8400
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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 | 896-025
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License Number State | WI
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