Provider Demographics
NPI:1962677526
Name:FOOT WELLNESS CENTER
Entity Type:Organization
Organization Name:FOOT WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZEROVEC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-271-0670
Mailing Address - Street 1:1839A E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2943
Mailing Address - Country:US
Mailing Address - Phone:414-271-0670
Mailing Address - Fax:414-271-2396
Practice Address - Street 1:1442 N FARWELL AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2996
Practice Address - Country:US
Practice Address - Phone:414-271-0670
Practice Address - Fax:414-271-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI802025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43269300Medicaid
WI1396822730OtherINDIVIDUAL NPI
WI43227900Medicaid
WI1396822730OtherINDIVIDUAL NPI
WI43227900Medicaid