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General NPI Number Information
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NPI Number | 1376598235
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE HEALTH CENTER, S.C.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 17000 W NORTH AVE SUITE 102E
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City | BROOKFIELD
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State | WI
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Zip | 53005-4423
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Country | US
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Telephone | 262-821-3980
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Fax | 262-821-3441
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Provider Business Mailing Address
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Address Line | 7400 W RAWSON AVE SUITE 231
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone | 414-831-0512
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL DEI
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Credential | DPM
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Telephone | 414-831-0512
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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 | 575-025
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License Number State | WI
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