Provider Demographics
NPI:1134885809
Name:COMPREHENSIVE PODIATRY SERVICES
Entity type:Organization
Organization Name:COMPREHENSIVE PODIATRY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:142-568-3304
Mailing Address - Street 1:7971 SOUTH SIXTH STREET
Mailing Address - Street 2:STE 322
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2034
Mailing Address - Country:US
Mailing Address - Phone:414-253-8330
Mailing Address - Fax:414-244-9957
Practice Address - Street 1:803 W LAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2426
Practice Address - Country:US
Practice Address - Phone:414-253-8330
Practice Address - Fax:414-244-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty