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General NPI Number Information
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NPI Number | 1801018569
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Entity Type | Organization
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Legal Business Name | CZARNECKI PODIATRY, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 940 BELL AVE SUITE A
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City | HARTFORD
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State | WI
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Zip | 53027-2913
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Country | US
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Telephone | 262-673-7779
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Fax | 262-673-5484
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Provider Business Mailing Address
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Address Line | 940 BELL AVE SUITE A
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City | HARTFORD
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State | WI
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Zip | 53027-2913
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Country | US
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Telephone | 262-673-7779
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Fax | 262-673-5484
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. THOMAS NICHOLAS CZARNECKI JR.
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Credential | D.P.M.
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Telephone | 262-673-7779
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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 | 025-519
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License Number State | WI
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