Organization
MIDWEST SPINE CENTER SC
Active
Organization
MIDWEST SPINE CENTER SC
Active
Other names
Midwest Spinal Center SC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES E STOLL JR. MD (PRESIDENT)
(414) 807-6128
Entity
Organization
Contact information
Practice address
525 W RIVER WOODS PKWY STE 240, GLENDALE, WI 53212-1010
(414) 807-6128
Mailing address
611 E LAKE HILL CT, MILWAUKEE, WI 53217-4351
(414) 807-6128
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26052
LICENSE
WI
Enumeration date
02/27/2021
Last updated
02/27/2021
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