1134885809 NPI number — COMPREHENSIVE PODIATRY SERVICES

Table of content: (NPI 1134885809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134885809 NPI number — COMPREHENSIVE PODIATRY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PODIATRY SERVICES
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:
1134885809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7971 SOUTH SIXTH STREET
Provider Second Line Business Mailing Address:
STE 322
Provider Business Mailing Address City Name:
OAK CREEK
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53154-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-253-8330
Provider Business Mailing Address Fax Number:
414-244-9957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 W LAYTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53221-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-253-8330
Provider Business Practice Location Address Fax Number:
414-244-9957
Provider Enumeration Date:
11/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ROSHAN
Authorized Official First Name:
SYEDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
142-568-3304

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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