Provider Demographics
NPI:1548452873
Name:WINONA FAMILY FOOT CARE, LTD
Entity type:Organization
Organization Name:WINONA FAMILY FOOT CARE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:NACHTIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-452-0994
Mailing Address - Street 1:111 MARKET ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5532
Mailing Address - Country:US
Mailing Address - Phone:507-452-0994
Mailing Address - Fax:507-452-1072
Practice Address - Street 1:3812 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9466
Practice Address - Country:US
Practice Address - Phone:507-452-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN505213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI81582200Medicaid
WI5801890002Medicare NSC