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Organization
MILWAUKEE CLINIC OF ORTHO SURGERY LTD
Active
Organization
MILWAUKEE CLINIC OF ORTHO SURGERY LTD
Active
Other names
Milwaukee Clinic of Orthopedic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY J BANACH (ADMINISTRATOR)
(414) 321-8960
Entity
Organization
Contact information
Practice address
19035 W CAPITOL DR, SUITE 101, BROOKFIELD, WI 53045-2755
(414) 321-8960
(414) 321-0632
Mailing address
5233 W MORGAN AVE, SUITE 102, MILWAUKEE, WI 53220-1541
(414) 321-8960
(414) 321-0632
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
—
WI
332B00000X
Durable Medical Equipment & Medical Supplies
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41716700
—
WI
Enumeration date
08/12/2009
Last updated
07/06/2010
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