Provider Demographics
NPI:1609003508
Name:VISSAT, ELIZABETH A (DPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:VISSAT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5900 S LAKE DR
Mailing Address - Street 2:2 WEST
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3171
Mailing Address - Country:US
Mailing Address - Phone:414-489-4190
Mailing Address - Fax:414-489-4015
Practice Address - Street 1:5900 S LAKE DR
Practice Address - Street 2:2 WEST
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110
Practice Address - Country:US
Practice Address - Phone:414-489-4190
Practice Address - Fax:414-489-4015
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WII005-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery