Derksen, Todd Alan

Derksen, Todd Alan is an individual health care provider with primary practice located at 1301 E Northland Ave Ste B, Appleton WI 54911. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Derksen, Todd Alan can be contacted via phone (920) 731-1999.

Contact Information

Primary practice address
1301 E Northland Ave Ste B Appleton WI 54911
Phone: (920) 731-1999
Fax: (920) 731-3729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 953-25 Wisconsin

Profile Details

NPI number 1053578682
LBN Legal business name Derksen, Todd Alan
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date May 21st, 2008
Last updated Aug 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053578682 NPPES
Wisconsin MEDICAID 43244900

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