# WOLF RIVER FAMILY FOOTCARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457480683
- **Authorized official:** DR. CARL JOSEPH SICILIANO D.P.M. (OWNER SOLE MEMBER)
- **Authorized official phone:** (901) 381-2800

## Contact information

- **Practice address:** 7424 US HIGHWAY 64, SUITE 119, BARTLETT, TN 38133-3986
- **Practice address phone:** (901) 381-2800
- **Practice address fax:** (901) 381-2677
- **Mailing address:** 7424 US HIGHWAY 64, SUITE 119, BARTLETT, TN 38133-3986
- **Mailing address phone:** (901) 381-2800
- **Mailing address fax:** (901) 381-2677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | DPM0000000422 | TN | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 06/05/2008