James C. Boudreau, DPM, SC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

349025 Issued in WI

Legal business name

JAMES C. BOUDREAU, DPM, SC

Practice address

6191 S. 108TH St.
Hales Corners, WI 53130

Phone

(414) 425-5140

Fax

(414) 425-7960

NPI assigned

Jul 31, 2006

Organization subpart

No

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

Authorized official

Name

Dr. James C. Boudreau, DPM

Title

President

Phone

(414) 425-5140

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1528074309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6191 S. 108TH ST.",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "53130",
            "telephone_number": "414-425-5140",
            "fax_number": "414-425-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6191 S. 108TH ST.",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "53130",
            "telephone_number": "414-425-5140",
            "fax_number": "414-425-7960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES C. BOUDREAU, DPM, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-425-5140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "349025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43260100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.