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Organization
WISCONSIN VISITING PODIATRY
Active
Organization
WISCONSIN VISITING PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA CARTER (CREDENTIALING MANAGER)
(262) 444-3132
Entity
Organization
Contact information
Practice address
28606 SANDPIPER TRL, WATERFORD, WI 53185-1733
(224) 234-7304
Mailing address
PO BOX 187, WATERFORD, WI 53185-0187
(262) 444-3132
(877) 636-1498
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43221600
—
WI
Enumeration date
11/04/2015
Last updated
01/27/2022
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