Provider Demographics
NPI:1235561473
Name:FAMILY FOOT & ANKLE CLINICS OF WISCONSIN LLC
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE CLINICS OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-657-6104
Mailing Address - Street 1:6123 GREEN BAY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2927
Mailing Address - Country:US
Mailing Address - Phone:262-657-3668
Mailing Address - Fax:
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:262-657-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty