DR. TODD A DERKSEN (NPI# 1053578682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053578682 |
| Entity Type | Individual |
| Full Name | DR. TODD A DERKSEN |
| Credential | D.P.M. |
| Practice Address |
2105 E. Enterprise Ave. Suite 111 Appleton WI 54913-7862 |
| Practice Telephone | 9207316611 |
| Practice Fax Number | 9207316732 |
| Mailing Telephone | 9207316611 |
| Mailing Fax Number | 9207316732 |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2015-12-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
953-25 | WI | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43244900 | 05 |
| Street Address |
2105 E. ENTERPRISE AVE. SUITE 111 |
| City | APPLETON |
| State | WI |
| Zip Code | 54913-7862 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043254162 | Fvosa Surgical Partners, LLC | Clinic/Center | 2105 E. Enterprise Ave., Suite 101, Appleton, WI 54913 | 2006-06-16 |
| 1467702241 | Kara L Brochtrup | Nurse Practitioner | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2012-09-19 |
| 1629218417 | Nicole E. Juedes | Specialist/Technologist, Other | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2009-03-06 |
| 1811179344 | Eric R. Bowen | Nurse Practitioner | 2105 E. Enterprise Ave., Suite 111, Appleton, WI 54913-7862 | 2007-11-27 |
| 1720023724 | Great Lakes Orthotics & Prosthetics Inc. | Prosthetic/Orthotic Supplier | 2105 E. Enterprise Ave., Suite 114, Appleton, WI 54913 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427073659 | Toni Jo Biese Neal | Podiatrist | 118 North Durkee Street, Appleton, WI 54911-5427 | 2006-07-12 |
| 1851812168 | Kurt Fleschner | Podiatrist | W2654 County Road Kk, Appleton, WI 54915-9468 | 2017-06-28 |
| 1154438810 | Neal Diabetic Foot and Ankle Center LLC | Podiatrist | 118 N Durkee St, Appleton, WI 54911-5427 | 2006-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225675697 | Grayco LLC | Podiatrist | 7128 Tamarack Ct, Mequon, WI 53092-8517 | 2019-12-04 |
| 1124688114 | Foot Factor Podiatry LLC | Podiatrist | 6125 Green Bay Rd Ste 600, Kenosha, WI 53142-2928 | 2019-06-20 |
| 1063928752 | Sheboygan Foot Care, LLC | Podiatrist | 630 Riverfront Dr Ste 202, Sheboygan, WI 53081-4616 | 2017-12-18 |
| 1295279461 | Colin T Graney | Podiatrist | 664 W. Washington Ave, Madison, WI 53703 | 2016-12-07 |
| 1790158368 | Wisconsin Visiting Podiatry | Podiatrist | 28606 Sandpiper Trl, Waterford, WI 53185-1733 | 2015-11-04 |
| 1225415540 | Alexander Blaschke | Podiatrist | 1009 Caledonia St, La Crosse, WI 54603 | 2015-05-06 |
| 1164861712 | Jessica Leigh Minder | Podiatrist | W62n179 Washington Ave Ste 3, Cedarburg, WI 53012-2770 | 2013-06-17 |
| 1326322884 | Northwoods Foot & Ankle LLC | Podiatrist | 1400 Us Highway 51 N, Unit G, Arbor Vitae, WI 54568-9504 | 2011-10-03 |
| 1336434075 | James David Torhorst | Podiatrist | 1439 Churchill St # 202, Waupaca, WI 54981-2089 | 2011-06-10 |
| 1154632412 | Anton John Sella | Podiatrist | 2835 N Grandview Blvd Ste 300, Pewaukee, WI 53072-5591 | 2010-07-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.