Provider Demographics
NPI:1811306434
Name:ALLIANCE FOOT & ANKLE CLINICS LLC
Entity type:Organization
Organization Name:ALLIANCE FOOT & ANKLE CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS JON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-768-8584
Mailing Address - Street 1:6510 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4563
Mailing Address - Country:US
Mailing Address - Phone:414-282-7209
Mailing Address - Fax:414-282-9948
Practice Address - Street 1:6510 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4563
Practice Address - Country:US
Practice Address - Phone:414-282-7209
Practice Address - Fax:414-282-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1026-25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty