Provider Demographics
NPI:1841483484
Name:FOOT & ANKLE HEALTH CENTER, S.C.
Entity type:Organization
Organization Name:FOOT & ANKLE HEALTH CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-381-0512
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8278
Mailing Address - Country:US
Mailing Address - Phone:414-831-0512
Mailing Address - Fax:414-321-2333
Practice Address - Street 1:3970 N OAKLAND AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2265
Practice Address - Country:US
Practice Address - Phone:414-332-6138
Practice Address - Fax:414-332-7348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT & ANKLE HEALTH CENTER, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI504-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43262700Medicaid
WI0223160007Medicare NSC