Organization
ORTHOPEDIC & SPORTS MEDICINE SPECIALISTS OF GREEN BAY, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE KLAUS (PROVIDER CREDENTIALING AND PRIVILEG)
(920) 965-9517
Entity
Organization
Contact information
Practice address
2223 LIME KILN RD, SUITE 1, GREEN BAY, WI 54311-6213
(920) 430-8120
(920) 430-8122
Mailing address
2223 LIME KILN RD, SUITE 1, GREEN BAY, WI 54311-6213
(920) 430-8120
(920) 430-8122
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21316600
—
WI
Enumeration date
10/10/2007
Last updated
04/28/2023
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