Provider Demographics
NPI:1891291167
Name:NORTHEAST WISCONSIN FOOT AND ANKLE ASSOC., S.C.
Entity Type:Organization
Organization Name:NORTHEAST WISCONSIN FOOT AND ANKLE ASSOC., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNADERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-702-5484
Mailing Address - Street 1:1301 E NORTHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8582
Mailing Address - Country:US
Mailing Address - Phone:920-702-5484
Mailing Address - Fax:920-224-7925
Practice Address - Street 1:225 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1243
Practice Address - Country:US
Practice Address - Phone:920-361-6285
Practice Address - Fax:920-361-5335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST WISCONSIN FOOT & ANKLE ASSOC., S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty