MEDICARE: DR. WILLIAM ROBERT REDISKE D.P.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	1546	TX
2	213ES0131X	Foot Surgery Podiatrist	1546	TX

General Provider Information

NPI Number	:	1134286024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ROBERT REDISKE D.P.M

Provider Business Mailing Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:	SUITE 203
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:	SUITE 203
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:	254-634-8818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/01/2022

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Directions to “ DR. WILLIAM ROBERT REDISKE D.P.M” Practice Location

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