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General NPI Number Information
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NPI Number | 1720056146
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF WAUSAU, S.C.
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 1630 CHIPPEWA DR
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City | RHINELANDER
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State | WI
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Zip | 54501-9503
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Country | US
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Telephone | 715-362-6813
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Fax | 715-362-6813
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Provider Business Mailing Address
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Address Line | 1445 MERRILL AVE
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City | WAUSAU
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State | WI
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Zip | 54401-2646
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Country | US
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Telephone | 715-675-2321
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Fax | 715-675-6530
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL E JOURDAN
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Credential | DPM
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Telephone | 715-675-2321
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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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