Organization
WISCONSIN SPINE AND PAIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JUNG (OWNER)
(414) 455-1153
Entity
Organization
Contact information
Practice address
2607 N GRANDVIEW BLVD, WAUKESHA, WI 53188-1686
(920) 204-6758
Mailing address
DEPT. CH 17057, PALATINE, IL 60055-7057
(920) 204-6758
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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