Provider Demographics
NPI:1154438810
Name:NEAL DIABETIC FOOT AND ANKLE CENTER LLC
Entity type:Organization
Organization Name:NEAL DIABETIC FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI JO
Authorized Official - Middle Name:BIESE
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MHA
Authorized Official - Phone:920-830-2221
Mailing Address - Street 1:W2654 COUNTY ROAD KK
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-830-2221
Mailing Address - Fax:920-257-2180
Practice Address - Street 1:W2654 COUNTY ROAD KK
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-830-2221
Practice Address - Fax:920-257-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI913-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5774600001OtherMEDICARE DMERC
WI43241700Medicaid
WI913-025OtherPODIATRIC MED & SURG LIC.
WIBN9786522OtherDEA REGISTRATION NUMBER
WIBN9786522OtherDEA REGISTRATION NUMBER
WI5774600001Medicare NSC