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General NPI Number Information
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NPI Number | 1891291167
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Entity Type | Organization
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Legal Business Name | NORTHEAST WISCONSIN FOOT AND ANKLE ASSOC., S.C.
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 225 MEMORIAL DR
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City | BERLIN
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State | WI
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Zip | 54923-1243
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Country | US
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Telephone | 920-361-6285
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Fax | 920-361-5335
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Provider Business Mailing Address
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Address Line | 1301 E NORTHLAND AVE STE B
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City | APPLETON
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State | WI
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Zip | 54911-8582
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Country | US
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Telephone | 920-702-5484
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Fax | 920-224-7925
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARILOU SCHNADERBECK
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Credential |
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Telephone | 920-702-5484
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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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