Provider Demographics
NPI:1073241774
Name:PATEL FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:PATEL FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-638-3435
Mailing Address - Street 1:6123 GREEN BAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2939
Mailing Address - Country:US
Mailing Address - Phone:262-657-3668
Mailing Address - Fax:262-652-0564
Practice Address - Street 1:6123 GREEN BAY RD STE 100
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2939
Practice Address - Country:US
Practice Address - Phone:262-657-3668
Practice Address - Fax:262-652-0564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT LAKES FOOT & ANKLE CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-10
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100210061Medicaid