Organization
PATEL FOOT & ANKLE LLC
Active
Parent organization
GREAT LAKES FOOT & ANKLE CENTERS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES FOOT & ANKLE CENTERS INC
Authorized official
PRIYA PATEL DPM (OWNER)
(847) 638-3435
Entity
Organization
Contact information
Practice address
6123 GREEN BAY RD STE 100, KENOSHA, WI 53142-2939
(262) 657-3668
(262) 652-0564
Mailing address
6123 GREEN BAY RD STE 100, KENOSHA, WI 53142-2939
(262) 657-3668
(262) 652-0564
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100210061
—
WI
Enumeration date
08/10/2022
Last updated
11/11/2022
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