Organization
ADVANCED FOOT AND ANKLE CENTER OF KENOSHA S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANA DEROUIN DPM (PRESIDENT)
(262) 652-6555
Entity
Organization
Contact information
Practice address
2901 35TH ST, LOWER LEVEL SOUTH, KENOSHA, WI 53140-5117
(262) 652-6555
Mailing address
2901 35TH ST, LOWER LEVEL SOUTH, KENOSHA, WI 53140-5117
(262) 652-6555
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1029-25
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598059354
NPI
IL
Enumeration date
07/20/2016
Last updated
07/20/2016
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