Organization
MILWAUKEE CLINIC OF ORTHO SURGERY LTD
Active
Other names
Milwaukee Clinic of Orthopedic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY J BANACH (ADMINISTRATOR)
(414) 321-8960
Entity
Organization
Contact information
Practice address
19035 W CAPITOL DR, SUITE 101, BROOKFIELD, WI 53045-2755
(414) 321-8960
(414) 321-0632
Mailing address
5233 W MORGAN AVE, SUITE 102, MILWAUKEE, WI 53220-1541
(414) 321-8960
(414) 321-0632
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
—
WI
332B00000X
Durable Medical Equipment & Medical Supplies
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41716700
—
WI
Enumeration date
08/12/2009
Last updated
07/06/2010
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