Organization
WOLF RIVER FAMILY FOOTCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL JOSEPH SICILIANO D.P.M. (OWNER SOLE MEMBER)
(901) 381-2800
Entity
Organization
Contact information
Practice address
7424 US HIGHWAY 64, SUITE 119, BARTLETT, TN 38133-3986
(901) 381-2800
(901) 381-2677
Mailing address
7424 US HIGHWAY 64, SUITE 119, BARTLETT, TN 38133-3986
(901) 381-2800
(901) 381-2677
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM0000000422
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG7179
MEDICARE ID TYPE UNSPECIFIED
TN
Enumeration date
03/05/2007
Last updated
06/05/2008
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