Provider Demographics
NPI:1992968093
Name:PLOVANICH, ELIZABETH J (DPM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:PLOVANICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3485
Mailing Address - Country:US
Mailing Address - Phone:608-831-8086
Mailing Address - Fax:608-442-0126
Practice Address - Street 1:6255 UNIVERSITY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3485
Practice Address - Country:US
Practice Address - Phone:608-831-8086
Practice Address - Fax:608-442-0126
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI967213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6505100001Medicare NSC