Organization
BAY AREA FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS R KOMP DPM (OWNER)
(920) 498-2226
Entity
Organization
Contact information
Practice address
2295 W MASON ST, GREEN BAY, WI 54303-4706
(920) 498-2226
Mailing address
2295 W MASON ST, GREEN BAY, WI 54303-4706
(920) 498-2226
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41732500
MEDICAID DME
WI
Enumeration date
11/14/2007
Last updated
07/17/2008
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