Provider Demographics
NPI:1558374975
Name:ALBANESE, ELIZABETH SHARON (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHARON
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E CADY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3911
Mailing Address - Country:US
Mailing Address - Phone:920-390-9215
Mailing Address - Fax:
Practice Address - Street 1:911 E CADY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3911
Practice Address - Country:US
Practice Address - Phone:920-390-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI960-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199797717Medicaid
0732240001OtherPPG GROUP DMERC #
ARP01192554OtherRAILROAD MEDICARE
WI1558374975Medicaid
WI864760020Medicare PIN
WIP00724583Medicare PIN
AR280378YKAUMedicare PIN
WI1558374975Medicaid
WI814350015Medicare PIN
AR280378YKAUMedicare PIN
WI850700015Medicare PIN
ARP01192554OtherRAILROAD MEDICARE
0732240001OtherPPG GROUP DMERC #
WI1558374975Medicaid
WI864920019Medicare PIN
WI865500016Medicare PIN
WI810150011Medicare PIN
WI864760020Medicare PIN