1851466940 NPI number — MAYFAIR FOOT CARE CLINIC S.C.

Table of content: (NPI 1851466940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851466940 NPI number — MAYFAIR FOOT CARE CLINIC S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYFAIR FOOT CARE CLINIC S.C.
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:
1851466940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10125 W NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-257-0676
Provider Business Mailing Address Fax Number:
414-774-2588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10125 W NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-257-0676
Provider Business Practice Location Address Fax Number:
414-774-2588
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILKIE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
414-257-0676

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CG2330 . This is a "RR GROUP #" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43215200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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