Provider Demographics
NPI:1588706626
Name:NORTHLAND PODICARE LTD.
Entity type:Organization
Organization Name:NORTHLAND PODICARE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KURTYKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-356-4255
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-1577
Mailing Address - Country:US
Mailing Address - Phone:715-356-4255
Mailing Address - Fax:715-358-6475
Practice Address - Street 1:9251 COUNTY RD J
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9251
Practice Address - Country:US
Practice Address - Phone:715-356-4255
Practice Address - Fax:715-358-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI591-025213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43267500Medicaid
WI86615Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WI43267500Medicaid