Provider Demographics
NPI:1164713509
Name:GREENVILLE FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:GREENVILLE FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:920-750-7900
Mailing Address - Street 1:N1697 MUNICIPAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-7700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N1697 MUNICIPAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-7700
Practice Address - Country:US
Practice Address - Phone:920-750-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI984025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
018498F73Medicare PIN
WI6596330001Medicare NSC
WI2321Medicare PIN