Provider Demographics
NPI:1073500526
Name:TIKALSKY, JOEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:J
Last Name:TIKALSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2405 SCHOFIELD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6421
Mailing Address - Country:US
Mailing Address - Phone:715-241-8100
Mailing Address - Fax:715-241-8102
Practice Address - Street 1:2405 SCHOFIELD AVE STE 110
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-6421
Practice Address - Country:US
Practice Address - Phone:715-241-8100
Practice Address - Fax:715-241-8102
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI895-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV04208Medicare UPIN