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Individual

MARK A ALDRICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
737 DORR ST, ANTIGO, WI 54409-1472
(715) 623-4710
(715) 627-2737
Mailing address
737 DORR ST, ANTIGO, WI 54409-1472
(715) 623-4710
(715) 627-2737

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
502025
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
391498774010
BLUE CROSS
WI
05
43208000
WI
01
5036
SECURITY HEALTH
WI
01
83-407
WPS PROVIDER NUMBER
WI
01
W002277
CHAMPUS PROVIDER NUMBER
WI
Enumeration date
09/09/2005
Last updated
07/28/2010
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