# CLINIC OF ORTHOPEDIC SURGERY CHTD

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

## Provider details

- **NPI number:** 1437240421
- **Authorized official:** ALAN W ROETKER MD (PRESIDENT)
- **Authorized official phone:** (920) 923-0641

## Contact information

- **Practice address:** 210 WISCONSIN AMERICAN DR, STE 235, FOND DU LAC, WI 54935-2999
- **Practice address phone:** (920) 923-0641
- **Practice address fax:** (920) 923-3281
- **Mailing address:** PO BOX 1358, 210 WISCONSIN AMERICAN DRIVE STE 235, FOND DU LAC, WI 54936-1358
- **Mailing address phone:** (920) 923-0641
- **Mailing address fax:** (920) 923-3281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 04/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 32745200 | — | WI |