Provider Demographics
NPI:1851919773
Name:FAMILY FOOT AND ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIKALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-241-8100
Mailing Address - Street 1:5403 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2217
Mailing Address - Country:US
Mailing Address - Phone:715-241-8100
Mailing Address - Fax:
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448-9646
Practice Address - Country:US
Practice Address - Phone:715-443-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FOOT AND ANKLE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty