# WISCONSIN SPORTS MEDICINE AND ORTHOPEDICS,S.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northeast Wisconsin Orthopedic Associates SC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861899833
- **Authorized official:** DENISE K STROOBANTS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (920) 445-7226

## Contact information

- **Practice address:** 820 ARBUTUS AVE, OCONTO, WI 54153-2004
- **Practice address phone:** (920) 593-5555
- **Practice address fax:** (920) 835-1099
- **Mailing address:** PO BOX 22487, GREEN BAY, WI 54305-2487
- **Mailing address phone:** (920) 445-7226
- **Mailing address fax:** (920) 445-7229

## Taxonomy

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

## Other

- **Enumeration date:** 11/19/2014
- **Last updated:** 12/09/2014