| NPI | 1871645333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MARIE BOECKER Office Manager 920-725-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 21334200) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2009-06-10 |