1063534030 NPI number — FOOT AND ANKLE ASSOCIATES OF WI LTD

Table of content: (NPI 1063534030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063534030 NPI number — FOOT AND ANKLE ASSOCIATES OF WI LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE ASSOCIATES OF WI LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063534030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 N GRANDVIEW BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53072-5591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-542-3779
Provider Business Mailing Address Fax Number:
262-542-4428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 N GRANDVIEW BLVD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
PEWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-542-3779
Provider Business Practice Location Address Fax Number:
262-542-4428
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALATI
Authorized Official First Name:
AMY
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
262-542-3779

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063660751 . This is a "AMY GALATI NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1619969391 . This is a "JAMES R VAVRA NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1902291818 . This is a "TYLER VELDKAMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1952393738 . This is a "THOMAS A PIETROCARLO NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1457356305 . This is a "SHAWN M SANICOLA NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1154632412 . This is a "ANTON SELLA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1063534030 . This is a "GRP NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1740773613 . This is a "JEREMY PHILIPSEN NPI" identifier . This identifiers is of the category "OTHER".




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