MEDICARE: COMMUNITY FOOT AND ANKLE CLINIC, INC.

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	213E00000X	Podiatrist	708	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480022037	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427049279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY FOOT AND ANKLE CLINIC, INC.

Provider Business Mailing Address
First Line	:	4100 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4410
Country	:	US
Telephone Number	:	414-483-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4410
Country	:	US
Telephone Number	:	414-483-5566
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. ISAAC TREJO
Credential	:	DPM
Telephone Number	:	414-483-5566

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	02/11/2014

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Directions to “COMMUNITY FOOT AND ANKLE CLINIC, INC. ” Practice Location

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