Provider Demographics
NPI:1346379203
Name:PLAZA PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PLAZA PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-258-5210
Mailing Address - Street 1:1439 CHURCHILL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2089
Mailing Address - Country:US
Mailing Address - Phone:715-258-5210
Mailing Address - Fax:715-258-5249
Practice Address - Street 1:1439 CHURCHILL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2089
Practice Address - Country:US
Practice Address - Phone:715-258-5210
Practice Address - Fax:715-258-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43239300Medicaid
WI43204800Medicaid
WI=========010OtherBLUE CROSS & BLUE SHIELD
WI43204800Medicaid
WI=========010OtherBLUE CROSS & BLUE SHIELD
WI43239300Medicaid
WIV05101Medicare UPIN