Provider Demographics
NPI:1568559789
Name:MIDWEST FOOT AND ANKLE, S.C.
Entity Type:Organization
Organization Name:MIDWEST FOOT AND ANKLE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-547-2900
Mailing Address - Street 1:113 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7604
Mailing Address - Country:US
Mailing Address - Phone:262-547-2900
Mailing Address - Fax:262-547-1440
Practice Address - Street 1:113 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7604
Practice Address - Country:US
Practice Address - Phone:262-547-2900
Practice Address - Fax:262-547-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI791-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF6534OtherRAILROAD MEDICARE
4764060001Medicare NSC