| Organization Name: | BEAVER DAM FOOT & ANKLE CENTER, INC. |
| NPI Number: | 1023204286 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROLF HARALD HANSEN (PODIATRIST) |
| Mailing Address: | 301 S Roosevelt Dr Beaver Dam |
| State: | WI US |
| Postal Code: | 539162439 |
| Phone Number: | 9208856434 |
| Fax Number: | 9208852640 |
| NPI Enumeration Date: | 09/21/2007 |
| NPI Last Update Date: | 11/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 865 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |