=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821968900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SHORE FOOT & ANKLE, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 CEAPE AVE
-----------------------------------------------------
City | OSHKOSH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54901-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-882-9990
-----------------------------------------------------
Fax | 920-882-9544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 S LAKE PARK RD
-----------------------------------------------------
City | APPLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54915-4155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-882-9990
-----------------------------------------------------
Fax | 920-882-9544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/OWNER
-----------------------------------------------------
Name | JAY LEE CHRISTENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-882-9990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------