Organization
GREAT LAKES FOOT & ANKLE OF GREATER MILWAUKEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D MATTEUCCI D.P.M. (MANAGER)
(414) 761-0981
Entity
Organization
Contact information
Practice address
8153 S 27TH ST, 400, FRANKLIN, WI 53132-9549
(414) 761-0981
Mailing address
8153 S 27TH ST, 400, FRANKLIN, WI 53132-9549
(414) 761-0981
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316101595
—
WI
01
—
WI1772
PTAN
WI
Enumeration date
07/16/2008
Last updated
12/27/2010
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