# MILWAUKEE CLINIC OF ORTHO SURGERY LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Milwaukee Clinic of Orthopedic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215169073
- **Authorized official:** MS. MARY J BANACH (ADMINISTRATOR)
- **Authorized official phone:** (414) 321-8960

## Contact information

- **Practice address:** 19035 W CAPITOL DR, SUITE 101, BROOKFIELD, WI 53045-2755
- **Practice address phone:** (414) 321-8960
- **Practice address fax:** (414) 321-0632
- **Mailing address:** 5233 W MORGAN AVE, SUITE 102, MILWAUKEE, WI 53220-1541
- **Mailing address phone:** (414) 321-8960
- **Mailing address fax:** (414) 321-0632

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | WI | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | WI | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | WI | — |

## Other

- **Enumeration date:** 08/12/2009
- **Last updated:** 07/06/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41716700 | — | WI |