Organization
ADVANCED FOOT & ANKLE CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFF CHISM DPM (PRESIDENT)
(715) 536-7444
Entity
Organization
Contact information
Practice address
410 E 2ND ST, MERRILL, WI 54452-2319
(715) 536-7444
(715) 536-1547
Mailing address
410 E 2ND ST, MERRILL, WI 54452
(715) 536-7444
(715) 536-1547
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
748
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485016
WI BLUE SHIELD
WI
01
—
000086520
RAILROAD MEDICARE
WI
01
—
1197940001
DMERC REGION B
—
05
—
43223800
—
WI
Enumeration date
07/20/2007
Last updated
04/07/2010
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