| NPI | 1861449720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA G. KORNELY Owner 262-335-2930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 774-025) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2022-02-01 |