| NPI | 1295788743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY J. BANACH Administrator 414-321-8960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-02-06 |