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General NPI Number Information
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NPI Number | 1841483484
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE HEALTH CENTER, S.C.
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 3970 N OAKLAND AVE SUITE 402
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City | SHOREWOOD
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State | WI
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Zip | 53211-2265
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Country | US
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Telephone | 414-332-6138
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Fax | 414-332-7348
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Provider Business Mailing Address
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Address Line | 7400 W RAWSON AVE SUITE 231
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City | FRANKLIN
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State | WI
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Zip | 53132-8278
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Country | US
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Telephone | 414-831-0512
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Fax | 414-321-2333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL L DEI
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Credential | DPM
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Telephone | 414-381-0512
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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 | 504-025
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License Number State | WI
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