Advanced Foot and Ankle Center of Kenosha S.C.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

1029-25 Issued in WI

Legal business name

ADVANCED FOOT AND ANKLE CENTER OF KENOSHA S.C.

Practice address

2901 35TH St
Lower Level South
Kenosha, WI 53140-5117

Phone

(262) 652-6555

NPI assigned

Jul 20, 2016

Last updated

Jul 20, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dana Derouin, DPM

Title

President

Phone

(262) 652-6555

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468972800000",
    "number": "1104279561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 35TH ST",
            "address_2": "LOWER LEVEL SOUTH",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405117",
            "telephone_number": "262-652-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 35TH ST",
            "address_2": "LOWER LEVEL SOUTH",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405117",
            "telephone_number": "262-652-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT AND ANKLE CENTER OF KENOSHA S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-20",
        "status": "A",
        "authorized_official_last_name": "DEROUIN",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-652-6555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "1029-25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1598059354",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Podiatrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.