Rock River Foot & Ankle Clinic, SC
Organization Active NPI Foot & Ankle Surgery Podiatrist · Juneau, WI
NPI 1710020649 · NPPES record last updated Nov 1, 2007
Key facts
- NPI
- 1710020649
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- ROCK RIVER FOOT & ANKLE CLINIC, SC
- Practice address
- 153 E Oak St
Juneau, WI 53039-1323 - Phone
- (920) 261-9610
- Fax
- (920) 261-9671
- NPI assigned
- Feb 14, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- ROCK RIVER FOOT & ANKLE CLINIC, SC
Authorized official
- Name
- Dr. Victor Stephen Soderstrom, D.P.M.
- Title
- President
- Phone
- (920) 261-9610
Corporate family (same tax ID) 8
Practitioners 1
-
Brent Paul Yaeggi, DPM
National Provider Directory
- Tax ID family
- Rock River Foot Ankle Clinic SC
- Part of
- Rock River Foot Ankle Clinic SC
Locations
153 E Oak St
Juneau, WI 53039
Phone (920) 261-9610
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | Yes |
Addresses
Primary practice location
153 E Oak St
Juneau, WI 53039-1323
Mailing address
101 Oakridge CT
Suite a
Watertown, WI 53094-4100
Phone (920) 261-9610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43264800 | Medicaid | WI |
Other providers in Juneau, WI
- Clara Pulvermacher
- Lindsay Radloff
- Amanda M Reda-Goglio
- Jill Marie Reifsnider
- Kerri Jean Ritsche
- Christopher Roorda
- Kayla Anne Ruff
- Thomas Deneen Rusch
- Barbara Rybold
- Mackenzie Saverino
All providers in Juneau, WI · Foot & Ankle Surgery Podiatrist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.