| NPI | 1144883299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HETTMANN Provider Credentialing Coordinator 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2022-04-13 |