Provider Demographics
NPI:1881615938
Name:ULTIMATE FOOT COMFORT CENTERS LLC
Entity type:Organization
Organization Name:ULTIMATE FOOT COMFORT CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-741-3338
Mailing Address - Street 1:2557 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0441
Mailing Address - Country:US
Mailing Address - Phone:608-741-3338
Mailing Address - Fax:608-741-3382
Practice Address - Street 1:2557 MILTON AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0441
Practice Address - Country:US
Practice Address - Phone:608-741-3338
Practice Address - Fax:608-741-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTAX ID NUMBER
WI5226230002Medicare ID - Type UnspecifiedMEDICARE