Provider Demographics
NPI:1316025893
Name:LAVORA, FRANK C (DPM)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:C
Last Name:LAVORA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100-15TH AVE
Mailing Address - Street 2:STE 180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-768-5430
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:4448 W LOOMIS RD
Practice Address - Street 2:STE 204
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4851
Practice Address - Country:US
Practice Address - Phone:414-281-1688
Practice Address - Fax:414-281-8170
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI663-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0010Medicare PIN
WI02120-0055Medicare PIN