Provider Demographics
NPI:1669445037
Name:HAIRSTON, VALERIA D (DPM)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:D
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:2555 N MARTIN LUTHER KING DR
Mailing Address - Street 2:MILWAUKEE HEALTH SERVICES, INC.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2709
Mailing Address - Country:US
Mailing Address - Phone:414-372-8080
Mailing Address - Fax:414-372-0793
Practice Address - Street 1:2555 N MARTIN LUTHER KING DR
Practice Address - Street 2:MILWAUKEE HEALTH SERVICES, INC.
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2709
Practice Address - Country:US
Practice Address - Phone:414-267-2840
Practice Address - Fax:414-562-8084
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD00974213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI026900106OtherMEDICARE PTAN
MD443048401Medicaid
MDRAILROAD MEDICAREOther480006442
MDT192VDOtherBLUE CROSS BLUE SHIELD
WI026900106OtherMEDICARE PTAN
MDT192Medicare PIN