# WISCONSIN LASER AND SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1871847319
- **Authorized official:** JONATHAN BAILEY (OFFICER/AO)
- **Authorized official phone:** (203) 609-1168

## Contact information

- **Practice address:** 10200 W INNOVATION DR, STE 700, MILWAUKEE, WI 53226-4825
- **Practice address phone:** (404) 302-9196
- **Mailing address:** 10200 W INNOVATION DR, MILWAUKEE, WI 53226-4825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/06/2012
- **Last updated:** 11/10/2024