Provider Demographics
NPI:1962756270
Name:ADVANCED FOOT & ANKLE OF WISCONSIN LLC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-763-9007
Mailing Address - Street 1:19035 W CAPITOL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2755
Mailing Address - Country:US
Mailing Address - Phone:262-763-9007
Mailing Address - Fax:262-763-8184
Practice Address - Street 1:19035 W CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2755
Practice Address - Country:US
Practice Address - Phone:262-763-9007
Practice Address - Fax:262-758-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI924-25213ES0103X
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty