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Organization
NORTHERN WISCONSIN BONE & JOINT CENTER, LTD
Active
Organization
NORTHERN WISCONSIN BONE & JOINT CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M TADYCH (CORPORATE SECRETARY)
(715) 358-1911
Entity
Organization
Contact information
Practice address
1630 N CHIPPEWA DR, RHINELANDER, WI 54501
(715) 361-5480
Mailing address
7520 US HIGHWAY 51 S, MINOCQUA, WI 54548-8943
(715) 358-1911
(715) 358-6158
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
29520-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1052540001
DMERC
WI
05
—
21298800
—
WI
01
—
CQ2410
RR MEDICARE
WI
Enumeration date
02/25/2008
Last updated
04/20/2008
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