Provider Demographics
NPI:1750391801
Name:WALDMAN, STEVEN M (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MICHELLE WITMER MEMORIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5281
Mailing Address - Country:US
Mailing Address - Phone:262-821-1588
Mailing Address - Fax:262-821-6644
Practice Address - Street 1:3610 MICHELLE WITMER MEMORIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5281
Practice Address - Country:US
Practice Address - Phone:262-821-1588
Practice Address - Fax:262-821-6644
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI579213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
85899OtherWPS
0957820001OtherDME
4281709OtherAETNA
WI43212600Medicaid
70866OtherUNITED HEALTHCARE
759170Other1ST HEALTH
0957820001OtherDME