Provider Demographics
NPI:1376598235
Name:FOOT AND ANKLE HEALTH CENTER, S.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE HEALTH CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-831-0512
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8278
Mailing Address - Country:US
Mailing Address - Phone:414-831-0512
Mailing Address - Fax:
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:SUITE 102E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-821-3980
Practice Address - Fax:262-821-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI575-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43262700Medicaid
WICC7747OtherMED RR
WI43262700Medicaid