Organization
FAMILY FOOT CLINICS OF WISCONSIN SC
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALYSSA K STEPHENSON DPM (PRESIDENT)
(262) 637-8806
Entity
Organization
Contact information
Practice address
3535 30TH AVE, #203, KENOSHA, WI 53144-1632
(262) 657-6104
(262) 657-6194
Mailing address
3535 30TH AVE, 203, KENOSHA, WI 53144-1632
(262) 637-8806
(262) 637-2868
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43260300
—
WI
Enumeration date
09/05/2007
Last updated
01/27/2012
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