Provider Demographics
NPI:1780770396
Name:CLEMENT, ROSANNE B (DPM)
Entity type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:B
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 SOUTH 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228
Mailing Address - Country:US
Mailing Address - Phone:414-327-2770
Mailing Address - Fax:414-327-0338
Practice Address - Street 1:3870 SOUTH 108TH STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1308
Practice Address - Country:US
Practice Address - Phone:414-327-2770
Practice Address - Fax:414-327-0338
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI677213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43218600Medicaid
WIU42979Medicare UPIN
WI000486675Medicare ID - Type Unspecified