Organization
GREAT LAKES MEDICAL LLC
Active
Parent organization
GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLC
Authorized official
DR. JOHN L BOSTANCHE DPM (DIRECTOR)
(262) 657-3668
Entity
Organization
Contact information
Practice address
8153 S 27TH ST, FRANKLIN, WI 53132-7012
(773) 885-7696
(773) 409-5710
Mailing address
DEPARTMENT 7917, CAROL STREAM, IL 60122
(773) 885-7696
(773) 409-5710
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/15/2009
Last updated
03/15/2011
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