Provider Demographics
NPI:1093963456
Name:WAUSAU PODIATRY CENTER LTD
Entity Type:Organization
Organization Name:WAUSAU PODIATRY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDERS
Authorized Official - Middle Name:V
Authorized Official - Last Name:JUVONEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMP
Authorized Official - Phone:715-842-4288
Mailing Address - Street 1:115 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2929
Mailing Address - Country:US
Mailing Address - Phone:715-842-4288
Mailing Address - Fax:715-842-2162
Practice Address - Street 1:115 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2929
Practice Address - Country:US
Practice Address - Phone:715-842-4288
Practice Address - Fax:715-842-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI437213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43241200Medicaid
000082391Medicare PIN
WIT62361Medicare UPIN
WI0979180001Medicare NSC