Provider Demographics
NPI:1053381566
Name:MIGON, JILL (DPM)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MIGON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3485
Mailing Address - Country:US
Mailing Address - Phone:608-831-8086
Mailing Address - Fax:608-442-0126
Practice Address - Street 1:6255 UNIVERSITY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3485
Practice Address - Country:US
Practice Address - Phone:608-831-8086
Practice Address - Fax:608-442-0126
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI915-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43241600Medicaid
WI43241600Medicaid
WIV09284Medicare UPIN