| NPI | 1376129833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HETTMANN Sr. Provider Credentialing Coord. 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207T00000X Neurological Surgery |
| 207W00000X Ophthalmology | |
| 208800000X Urology | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-08-23 |