Organization
NORTHERN WISCONSIN BONE & JOINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN LEE TADYCH M.D. (PRESIDENT/OWNER)
(715) 358-1911
Entity
Organization
Contact information
Practice address
601 S 7TH ST, ONTONAGON, MI 49953-1448
(715) 358-1911
(715) 358-1912
Mailing address
7520 HWY 51 S, MINOCQUA, WI 54548-8943
(715) 358-1911
(715) 358-1912
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000044000
MEDICARE ID-TYPE UNSPECIFIED
WI
01
—
1052540001
DMERC NUMBER
—
05
—
21298800
—
WI
Enumeration date
04/13/2010
Last updated
04/29/2010
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