Organization
LAKE COUNTRY FOOT & ANKLE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN DANIEL MEYER DPM (PRESIDENT)
(262) 695-6440
Entity
Organization
Contact information
Practice address
1177 QUAIL CT STE 103, PEWAUKEE, WI 53072-3768
(262) 695-6440
(262) 695-2668
Mailing address
1177 QUAIL CT STE 103, PEWAUKEE, WI 53072-3768
(262) 695-6440
(262) 695-2668
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
794-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000082018
P10
WI
Enumeration date
05/25/2012
Last updated
05/25/2012
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