Provider Demographics
NPI:1043509789
Name:A PLUS PODIATRY & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:A PLUS PODIATRY & SPORTS MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRUTE
Authorized Official - Middle Name:BALCIUNAS
Authorized Official - Last Name:SCHLECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:262-652-6555
Mailing Address - Street 1:2901 35TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5119
Mailing Address - Country:US
Mailing Address - Phone:262-652-6555
Mailing Address - Fax:262-652-7414
Practice Address - Street 1:2901 35TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5119
Practice Address - Country:US
Practice Address - Phone:262-652-6555
Practice Address - Fax:262-652-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI711-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000083491OtherMEDICARE ID
WI43221800Medicaid
WI43221800Medicaid
WI4628310002Medicare NSC