Provider Demographics
NPI:1689628802
Name:UNIVERSITY PODIATRY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:UNIVERSITY PODIATRY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:608-831-8086
Mailing Address - Street 1:450 S YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1068
Mailing Address - Country:US
Mailing Address - Phone:608-831-8086
Mailing Address - Fax:608-442-0126
Practice Address - Street 1:450 S YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1068
Practice Address - Country:US
Practice Address - Phone:608-831-8086
Practice Address - Fax:608-442-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43265000Medicaid
WI43265000Medicaid