Provider Demographics
NPI:1043358013
Name:ADVANCED FOOT CARE S C
Entity type:Organization
Organization Name:ADVANCED FOOT CARE S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOLFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:920-457-6104
Mailing Address - Street 1:1714 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2734
Mailing Address - Country:US
Mailing Address - Phone:920-457-6104
Mailing Address - Fax:920-457-6105
Practice Address - Street 1:1714 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2734
Practice Address - Country:US
Practice Address - Phone:920-457-6104
Practice Address - Fax:920-457-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI634213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43265900Medicaid
WIT91952Medicare UPIN
WI5046560001Medicare NSC