Provider Demographics
NPI:1801018569
Name:CZARNECKI PODIATRY, INC.
Entity Type:Organization
Organization Name:CZARNECKI PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CZARNECKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-673-7779
Mailing Address - Street 1:940 BELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2913
Mailing Address - Country:US
Mailing Address - Phone:262-673-7779
Mailing Address - Fax:262-673-5484
Practice Address - Street 1:940 BELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2913
Practice Address - Country:US
Practice Address - Phone:262-673-7779
Practice Address - Fax:262-673-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI025-519213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43268400Medicaid
WI1002790002Medicare NSC
WI43268400Medicaid