Provider Demographics
NPI:1699818419
Name:MCIVER FOOT CLINIC, INC.
Entity Type:Organization
Organization Name:MCIVER FOOT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-344-6788
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1466
Mailing Address - Country:US
Mailing Address - Phone:262-788-9229
Mailing Address - Fax:262-788-9241
Practice Address - Street 1:7903 WEST CAPITOL DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1903
Practice Address - Country:US
Practice Address - Phone:414-344-6788
Practice Address - Fax:414-344-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43265100Medicaid
WI=========012OtherBCBS
WI=========012OtherBCBS
WI5478200001Medicare NSC