Organization
WHITEFISH BAY FOOT & ANKLE CLINC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BOUDREAU DP (PODIATRIST / OWNER)
(414) 967-1900
Entity
Organization
Contact information
Practice address
155 E SILVER SPRING DR STE 205, WHITEFISH BAY, WI 53217-4704
(414) 967-1900
(414) 967-1926
Mailing address
PO BOX 11430, MILWAUKEE, WI 53211-0430
(414) 962-9070
(414) 962-9050
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43266800
—
WI
Enumeration date
10/02/2006
Last updated
03/10/2008
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