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General NPI Number Information
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NPI Number | 1679502843
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Entity Type | Organization
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Legal Business Name | ASSOCIATED FOOT & ANKLE CLINIC LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2950 PRAIRIE AVENUE 3
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City | BELOIT
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State | WI
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Zip | 53511-1899
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Country | US
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Telephone | 608-362-0758
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Fax | 608-362-7310
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Provider Business Mailing Address
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Address Line | 2950 PRAIRIE AVENUE 3
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City | BELOIT
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State | WI
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Zip | 53511-1899
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Country | US
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Telephone | 608-362-0758
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Fax | 608-362-7310
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Authorized Official
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Title or Position | CO OWNER PODIATRIST
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Name | DR. ROBERT M SAGE
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Credential | DPM
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Telephone | 608-362-0758
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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 |
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License Number State |
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