Organization Name: | PENINSULA PODIATRY LLC |
NPI Number: | 1255425088 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRADLEY GERARD BURKART (MANAGING PARTNER) |
Mailing Address: | Bldg 4 2 30 North 18th Avenue Sturgeon Bay |
State: | WI US |
Postal Code: | 542353207 |
Phone Number: | 9207436668 |
Fax Number: | 9207439222 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 02/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |