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Organization
PODOMEDIK CLINICS
Active
Organization
PODOMEDIK CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARDO PEREZ-ESPINDOLA DPM (OWNER PHYSICIAN)
(856) 520-4513
Entity
Organization
Contact information
Practice address
425 SHORELAND DR, RACINE, WI 53402-3829
(847) 249-3888
Mailing address
425 SHORELAND DR, RACINE, WI 53402-3829
(847) 249-3888
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
911-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000082037
MEDICARE PTAN
WI
01
—
000082039
MEDICARE PTAN
WI
01
—
215839
MEDICARE PTAN
IL
Enumeration date
01/02/2009
Last updated
01/02/2009
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