Individual
LAWRENCE JOHN MACIOLEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 W RIVER WOODS PARKWAY, SUITE 130, GLENDALE, WI 53212
(414) 961-0304
(414) 961-2061
Mailing address
575 W RIVER WOODS PKWY, SUITE 100, GLENDALE, WI 53212-1003
(414) 332-6262
(414) 332-0422
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
45567-020
WI
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
45567-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34908400
—
WI
Enumeration date
06/30/2006
Last updated
11/06/2019
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