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General NPI Number Information
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NPI Number | 1588706626
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Entity Type | Organization
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Legal Business Name | NORTHLAND PODICARE LTD.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9251 COUNTY RD J
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City | MINOCQUA
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State | WI
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Zip | 54548-9251
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Country | US
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Telephone | 715-356-4255
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Fax | 715-358-6475
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Provider Business Mailing Address
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Address Line | PO BOX 1577
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City | WOODRUFF
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State | WI
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Zip | 54568-1577
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Country | US
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Telephone | 715-356-4255
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Fax | 715-358-6475
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CATHERINE MARIE KURTYKA
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Credential |
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Telephone | 715-356-4255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 591-025
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License Number State | WI
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