Provider Demographics
NPI:1023727690
Name:ALLIANCE FOOT AND ANKLE CLINICS, LLC
Entity type:Organization
Organization Name:ALLIANCE FOOT AND ANKLE CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:JON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-282-7209
Mailing Address - Street 1:1344 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-2835
Mailing Address - Country:US
Mailing Address - Phone:262-731-0077
Mailing Address - Fax:414-282-9948
Practice Address - Street 1:1344 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-2835
Practice Address - Country:US
Practice Address - Phone:262-731-0077
Practice Address - Fax:414-282-9948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE FOOT AND ANKLE CLINICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty