NPI 1104279561

Advanced Foot and Ankle Center of Kenosha S.C.

Organisation Podiatrist Kenosha, WI

Practice location

Address: 2901 35th St Lower Level South, Kenosha, WI 53140-5117
Phone: (262) 652-6555

Authorised official

Name: Dana Derouin
Title: President
Phone: (262) 652-6555

Registered specialties

Podiatrist Primary

Podiatric Medicine & Surgery Service Providers Taxonomy 213E00000X Licence 1029-25 (WI)

Other Podiatrist providers in Wisconsin →

Registry record

NPI: 1104279561
Entity type: Organization
NPI issued: 20 Jul 2016
Record last updated: 20 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.