MEDICARE: ORTHOPAEDIC ASSOCIATES OF WISCONSIN SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	208100000X	Physical Medicine & Rehabilitation Physician	WI
3	207X00000X	Orthopaedic Surgery Physician	WI

General Provider Information

NPI Number	:	1720433790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC ASSOCIATES OF WISCONSIN SC

Provider Business Mailing Address
First Line	:	N15W28300 GOLF RD
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-4800
Country	:	US
Telephone Number	:	262-303-5055
Fax Number	:	262-303-5057

Provider Business Practice Location Address
First Line	:	1231 S ROCHESTER ST STE 100
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149
Country	:	US
Telephone Number	:	262-303-5055
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JON MICHAEL ENGLUND
Credential	:	MD
Telephone Number	:	262-303-5055

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	06/05/2026

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