MEDICARE: DR. VALERIA D HAIRSTON DPM

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	00974	MD
2	213E00000X	Podiatrist	957-25	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	026900106	OTHER	WI	MEDICARE PTAN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	T192VD	OTHER	MD	BLUE CROSS BLUE SHIELD
4	RAILROAD MEDICARE	OTHER	MD	480006442

General Provider Information

NPI Number	:	1669445037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIA D HAIRSTON DPM

Provider Business Mailing Address
First Line	:	2555 N MARTIN LUTHER KING DR
Second Line	:	MILWAUKEE HEALTH SERVICES, INC.
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2709
Country	:	US
Telephone Number	:	414-372-8080
Fax Number	:	414-372-0793

Provider Business Practice Location Address
First Line	:	2555 N DR MARTIN LUTHER KING JR DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2709
Country	:	US
Telephone Number	:	414-372-8080
Fax Number	:	414-562-8084

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/03/2024

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Directions to “ DR. VALERIA D HAIRSTON DPM” Practice Location

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