Provider Demographics
NPI:1851466940
Name:MAYFAIR FOOT CARE CLINIC S.C.
Entity Type:Organization
Organization Name:MAYFAIR FOOT CARE CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-257-0676
Mailing Address - Street 1:10125 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-257-0676
Mailing Address - Fax:414-774-2588
Practice Address - Street 1:10125 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-257-0676
Practice Address - Fax:414-774-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICG2330OtherRR GROUP #
WI43215200Medicaid
WICG2330OtherRR GROUP #
WI43215200Medicaid