Provider Demographics
NPI:1598704793
Name:KREBSBACH, JOHN P (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KREBSBACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 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: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:414-831-0512
Practice Address - Fax:414-321-2333
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43212900Medicaid
WIT62492Medicare UPIN