| NPI | 1588170716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HETTMANN Provider Credentialing Coordinator 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2022-04-20 |