Provider Demographics
NPI:1578647335
Name:PHYSICIAN RESOURCE MANAGEMENT
Entity Type:Organization
Organization Name:PHYSICIAN RESOURCE MANAGEMENT
Other - Org Name:FOOT & ANKLE HEALTH CENTER NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-831-0301
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:414-831-0301
Mailing Address - Fax:414-321-2333
Practice Address - Street 1:7400 W RAWSON AVE
Practice Address - Street 2:SUITE 231
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8278
Practice Address - Country:US
Practice Address - Phone:414-831-0301
Practice Address - Fax:414-321-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty