| Organization Name: | LAKE COUNTRY FOOT & ANKLE SC |
| NPI Number: | 1245590017 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ETHAN DANIEL MEYER (PRESIDENT) |
| Mailing Address: | 1177 Quail Ct Ste 103 Pewaukee |
| State: | WI US |
| Postal Code: | 530723768 |
| Phone Number: | 2626956440 |
| Fax Number: | 2626952668 |
| NPI Enumeration Date: | 05/25/2012 |
| NPI Last Update Date: | 05/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 794-025 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |