Jason K. Boudreau in Glendale - Podiatrist
Jason K. Boudreau - NPI 1518959378
Jason K. Boudreau is a Podiatrist in Glendale, Wisconsin. Jason K. Boudreau practices all healthcare services and medical treatments related to Podiatrist. The NPI Number for Jason K. Boudreau is 1518959378. The last update date is 2012-06-07.
Jason K. Boudreau's current location address is 4425 N Port Washington Rd, Glendale, Wisconsin. You can contact this provider via phone number 4143193000. The mailing address for Jason K. Boudreau is 4425 N Port Washington Rd, Glendale, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jason K. Boudreau |
|---|---|
| Address | 4425 N Port Washington Rd, Glendale, Wisconsin |
| Phone Number | 4143193000 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | D.P.M. |
NPI Number Detail
| NPI Number | 1518959378 |
|---|---|
| Provider Enumeration Date | 2005-08-18 |
| Last Updated Date | 2012-06-07 |
Provider Mailing Address Detail
| Address | 4425 N Port Washington Rd |
|---|---|
| City | Glendale |
| State | Wisconsin (WI) |
| Post Code | 532121082 |
| Phone Number | 4143193000 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Podiatrist |
|---|---|
| Taxonomy | 213E00000X |
| Licence No | 803-025 |
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Definition: A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 43231600 | WI | -- |
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What is the unique identifier code issued to Jason K. Boudreau by the Centers for Medicare & Medicaid Services?
The Jason K. Boudreau has been assigned the NPI (National Provider Identifier) 1518959378. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Jason K. Boudreau's physical address?
The Jason K. Boudreau is physically located at 4425 N Port Washington Rd, in the city of Glendale, WI, with the postal code 532121082.
What is Jason K. Boudreau's specialized field of practice, and what is the corresponding taxonomy classification code?
The Jason K. Boudreau's area of specialization is Podiatrist, and the corresponding taxonomy code that categorizes this field of practice is 213E00000X.
When did Jason K. Boudreau receive its 1518959378 assignment?
The Jason K. Boudreau was assigned its 1518959378 on 2005-08-18, which is the date when this unique identifier was issued to the organization.
As of what date were the details pertaining to Jason K. Boudreau last refreshed?
The information related to the Jason K. Boudreau, including its address, specialty, and other relevant details, was last updated on 2012-06-07.