Provider Demographics
NPI:1659439321
Name:FAMILY FOOT AND ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIKALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-241-8100
Mailing Address - Street 1:5403 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2217
Mailing Address - Country:US
Mailing Address - Phone:715-241-8100
Mailing Address - Fax:715-241-8102
Practice Address - Street 1:5403 NORMANDY ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2217
Practice Address - Country:US
Practice Address - Phone:715-241-8100
Practice Address - Fax:715-241-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI895-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty