Organization Name: | PLAZA PODIATRY ASSOCIATES LLC |
NPI Number: | 1346379203 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM BRIAN QUINN (OWNER) |
Mailing Address: | 1439 Churchill St Suite 202 Waupaca |
State: | WI US |
Postal Code: | 549812089 |
Phone Number: | 7152585210 |
Fax Number: | 7152585249 |
NPI Enumeration Date: | 03/05/2007 |
NPI Last Update Date: | 04/20/2008 |
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: |