| Organization Name: | MARK A. ALDRICH, D.P.M., INC. |
| NPI Number: | 1114385960 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK A ALDRICH (PRESIDENT) |
| Mailing Address: | 737 Dorr St Antigo |
| State: | WI US |
| Postal Code: | 544091472 |
| Phone Number: | 7156234710 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2016 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | 502-025 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |