Provider Demographics
NPI:1679608392
Name:ADVANCED FOOT & ANKLE OF WISCONSIN LLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KOKAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-763-9007
Mailing Address - Street 1:1050 S MILWAUKEE AVENUE
Mailing Address - Street 2:STE 102
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1380
Mailing Address - Country:US
Mailing Address - Phone:262-763-9007
Mailing Address - Fax:262-758-6134
Practice Address - Street 1:1050 S MILWAUKEE AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-5310
Practice Address - Country:US
Practice Address - Phone:262-763-9007
Practice Address - Fax:262-758-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43268700Medicaid
WI43268700Medicaid
WI000052088Medicare PIN