Organization
WISCONSIN LASER AND SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BAILEY (OFFICER/AO)
(203) 609-1168
Entity
Organization
Contact information
Practice address
10200 W INNOVATION DR, STE 700, MILWAUKEE, WI 53226-4825
(404) 302-9196
Mailing address
10200 W INNOVATION DR, MILWAUKEE, WI 53226-4825
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/06/2012
Last updated
11/10/2024
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