Provider Demographics
NPI:1881817161
Name:ACHILLES FOOT AND ANKLE CLINIC SC
Entity Type:Organization
Organization Name:ACHILLES FOOT AND ANKLE CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-358-9777
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:728 ELM STREET
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568
Mailing Address - Country:US
Mailing Address - Phone:715-358-9777
Mailing Address - Fax:715-358-9737
Practice Address - Street 1:728 ELM STREET
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568
Practice Address - Country:US
Practice Address - Phone:715-358-9777
Practice Address - Fax:715-358-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43228400Medicaid
WI000044045Medicare ID - Type Unspecified
WI43228400Medicaid