Provider Demographics
NPI:1285894055
Name:SOCKRIDER, NATHAN D (DPM)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:SOCKRIDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N JACKSON ST
Mailing Address - Street 2:APT 511
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6126
Mailing Address - Country:US
Mailing Address - Phone:262-554-7004
Mailing Address - Fax:
Practice Address - Street 1:3500 MEACHEM RD
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4681
Practice Address - Country:US
Practice Address - Phone:262-554-7004
Practice Address - Fax:262-554-7833
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI926025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist