Provider Demographics
NPI:1184837353
Name:NORTH SHORE FOOT & ANKLE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTH SHORE FOOT & ANKLE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (CEO)
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:920-882-9990
Mailing Address - Street 1:2005 S LAKE PARK RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4155
Mailing Address - Country:US
Mailing Address - Phone:920-882-9990
Mailing Address - Fax:920-882-9544
Practice Address - Street 1:2005 S LAKE PARK RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4155
Practice Address - Country:US
Practice Address - Phone:920-882-9990
Practice Address - Fax:920-882-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI616-025261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical