Organization
PORT WASHINGTON PODIATRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY JOSEPH BONGIORNO DPM (PRESIDENT)
(262) 284-8800
Entity
Organization
Contact information
Practice address
1317 W GRAND AVENUE, PORT WASHINGTON PODIATRY, PORT WASHINGTON, WI 53074
(262) 284-8800
(262) 284-8861
Mailing address
2132 WILLOW POND WAY, GRAFTON, WI 53024-9102
(262) 284-8800
(262) 284-8861
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
798025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43268200
—
WI
01
—
DB0746
RR MCR
—
Enumeration date
06/20/2006
Last updated
04/20/2008
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