=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871651570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAUKESHA FOOT SPECIALIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 E MORELAND BLVD
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-544-0700
-----------------------------------------------------
Fax | 262-544-9017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 E MORELAND BLVD
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-544-0700
-----------------------------------------------------
Fax | 262-544-9017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. RONALD ARNOLD
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 262-544-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------