MEDICARE: REGINA FLIPPIN 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	213ES0103X	Foot & Ankle Surgery Podiatrist	919.25	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00426599	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09932334	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	391868935019	OTHER	WI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1720019250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA FLIPPIN DPM

Provider Business Mailing Address
First Line	:	3915 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2528
Country	:	US
Telephone Number	:	414-444-9242
Fax Number	:	414-444-9252

Provider Business Practice Location Address
First Line	:	3915 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2528
Country	:	US
Telephone Number	:	414-444-9242
Fax Number	:	414-444-9252

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/11/2008

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Directions to “ REGINA FLIPPIN DPM” Practice Location

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