Provider Demographics
NPI:1750503512
Name:FOOT & ANKLE HEALTH CARE SC
Entity Type:Organization
Organization Name:FOOT & ANKLE HEALTH CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-654-9181
Mailing Address - Street 1:6707 39 AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142
Mailing Address - Country:US
Mailing Address - Phone:262-654-9181
Mailing Address - Fax:262-654-3330
Practice Address - Street 1:6707 39 AVENUE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:262-654-9181
Practice Address - Fax:262-654-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI772025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDA9868OtherRAIL ROAD MEDICARE GROUP PTAN
WI43266500Medicaid
WIDA9868OtherRAIL ROAD MEDICARE GROUP PTAN
WI43266500Medicaid