Organization
FAMILY FOOT CLINIC, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN CHARLES FURNESS DPM (PRESIDENT)
(920) 921-1669
Entity
Organization
Contact information
Practice address
21 S MARR ST, FOND DU LAC, WI 54935-4334
(920) 921-1669
(920) 921-7950
Mailing address
21 S MARR ST, FOND DU LAC, WI 54935-4334
(920) 921-1669
(920) 921-7950
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43264100
—
WI
01
—
CQ2458
RR/MEDICARE
WI
Enumeration date
09/07/2006
Last updated
05/21/2010
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