Provider Demographics
NPI:1326299553
Name:WISCONSIN FOOT CENTER, LLC
Entity Type:Organization
Organization Name:WISCONSIN FOOT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-425-8400
Mailing Address - Street 1:6130 S 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2525
Mailing Address - Country:US
Mailing Address - Phone:414-425-8400
Mailing Address - Fax:414-425-8425
Practice Address - Street 1:6130 S 108TH STREET
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2525
Practice Address - Country:US
Practice Address - Phone:414-425-8400
Practice Address - Fax:414-425-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI896-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDO9353OtherRAIL ROAD MEDICARE GROUP PTAN #
WIDO9353OtherRAIL ROAD MEDICARE GROUP PTAN #
WIV05101Medicare UPIN