| Organization Name: | WHITEFISH BAY FOOT & ANKLE CLINC, LLC |
| NPI Number: | 1003909847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JASON BOUDREAU (PODIATRIST / OWNER) |
| Mailing Address: | 155 E Silver Spring Dr Ste 205 Whitefish Bay |
| State: | WI US |
| Postal Code: | 532174704 |
| Phone Number: | 4149671900 |
| Fax Number: | 4149671926 |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 03/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |