Individual
DR. CHARLES HARRY HADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
940 PEPPER AVE, WISCONSIN RAPIDS, WI 54494-6307
(715) 421-4344
(715) 421-4341
Mailing address
940 PEPPER AVE, WISCONSIN RAPIDS, WI 54494-6307
(715) 421-4344
(715) 421-4341
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
414-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137751120246
HUMANA
WI
01
—
39-1318842
WEA TRUST
WI
01
—
391318842E00
BLUE CROSS BLUE SHIELD
WI
05
—
43225600
—
WI
Enumeration date
07/18/2006
Last updated
09/08/2008
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