Provider Demographics
NPI:1396827655
Name:FOOT & ANKLE SPECIALISTS SC
Entity Type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-258-8945
Mailing Address - Street 1:7423 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4614
Mailing Address - Country:US
Mailing Address - Phone:414-328-3806
Mailing Address - Fax:414-328-3818
Practice Address - Street 1:7423 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4614
Practice Address - Country:US
Practice Address - Phone:414-328-3806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43266900Medicaid
WI82030Medicare ID - Type Unspecified
WI43266900Medicaid