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General NPI Number Information
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NPI Number | 1417141227
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT CLINICS OF WISCONSIN SC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 3535 30TH AVE #203
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-657-6104
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Fax | 262-657-6194
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Provider Business Mailing Address
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Address Line | 3535 30TH AVE 203
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-637-8806
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Fax | 262-637-2868
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALYSSA K STEPHENSON
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Credential | DPM
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Telephone | 262-637-8806
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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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