| Advanced Foot & Ankle Of Wisconsin Llc | |
|
1050 S Milwaukee Avenue Ste 102 Burlington WI 53105-5310 | |
| (262) 763-9007 | |
| (262) 758-6134 |
| Full Name | Advanced Foot & Ankle Of Wisconsin Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1050 S Milwaukee Avenue, Burlington, Wisconsin |
| Authorized Official Name and Position | Michael Edward Kokat (CEO) |
| Authorized Official Contact | 2627639007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Foot & Ankle Of Wisconsin Llc 1050 S Milwaukee Avenue Ste 102 Burlington WI 53105-1380 Ph: (262) 763-9007 | Advanced Foot & Ankle Of Wisconsin Llc 1050 S Milwaukee Avenue Ste 102 Burlington WI 53105-5310 Ph: (262) 763-9007 |
| NPI Number | 1679608392 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 01/21/2022 |
| Medicare PECOS PAC ID | 0547367344 |
|---|---|
| Medicare Enrollment ID | O20070511000463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679608392 | NPI | - | NPPES |
| 43268700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Michael Nute |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1376597229 PECOS PAC ID: 7113932120 Enrollment ID: I20060213000514 |
| Provider Name | Michael E Kokat |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1780607200 PECOS PAC ID: 0446252902 Enrollment ID: I20070511000478 |
| Provider Name | Timothy J Henke |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689929499 PECOS PAC ID: 6800012832 Enrollment ID: I20140728000558 |
| Provider Name | Sehrish Rana |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144754276 PECOS PAC ID: 0345513743 Enrollment ID: I20220725002183 |
| Provider Name | Christopher James Dietzman |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1679172027 PECOS PAC ID: 3375903206 Enrollment ID: I20230724002007 |
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