Provider Demographics
NPI:1336281559
Name:STANS BOOTERY INC
Entity Type:Organization
Organization Name:STANS BOOTERY INC
Other - Org Name:STANS FIT FOR YOUR FEET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAJDAK
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:414-464-1960
Mailing Address - Street 1:4001A W LOOMIS ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221
Mailing Address - Country:US
Mailing Address - Phone:414-464-1960
Mailing Address - Fax:414-464-4383
Practice Address - Street 1:17155D W BLUEMOUND ROAD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-821-1130
Practice Address - Fax:262-821-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41625600Medicaid
WI0434650001Medicare ID - Type Unspecified