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General NPI Number Information
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NPI Number | 1659551083
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Entity Type | Organization
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Legal Business Name | BAY AREA FOOT CLINIC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 2295 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4706
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Country | US
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Telephone | 920-498-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4706
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Country | US
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Telephone | 920-498-2226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS R KOMP
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Credential | DPM
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Telephone | 920-498-2226
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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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