# NORTHERN WISCONSIN BONE & JOINT CENTER, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396914214
- **Authorized official:** MRS. LISA M TADYCH (CORPORATE SECRETARY)
- **Authorized official phone:** (715) 358-1911

## Contact information

- **Practice address:** 1630 N CHIPPEWA DR, RHINELANDER, WI 54501
- **Practice address phone:** (715) 361-5480
- **Mailing address:** 7520 US HIGHWAY 51 S, MINOCQUA, WI 54548-8943
- **Mailing address phone:** (715) 358-1911
- **Mailing address fax:** (715) 358-6158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 29520-020 | WI | Yes |

## Other

- **Enumeration date:** 02/25/2008
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1052540001 | DMERC | WI |
| 05 | — | 21298800 | — | WI |
| 01 | — | CQ2410 | RR MEDICARE | WI |