Organization
CLINIC OF ORTHOPEDIC SURGERY CHTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN W ROETKER MD (PRESIDENT)
(920) 923-0641
Entity
Organization
Contact information
Practice address
210 WISCONSIN AMERICAN DR, STE 235, FOND DU LAC, WI 54935-2999
(920) 923-0641
(920) 923-3281
Mailing address
PO BOX 1358, 210 WISCONSIN AMERICAN DRIVE STE 235, FOND DU LAC, WI 54936-1358
(920) 923-0641
(920) 923-3281
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32745200
—
WI
Enumeration date
09/27/2006
Last updated
04/07/2008
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