MEDICARE: MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1811635949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1297
Second Line	:
City	:	BEDFORD PARK
State	:	IL
Zip	:	60499-1297
Country	:	US
Telephone Number	:	414-295-9045
Fax Number	:	414-240-3162

Provider Business Practice Location Address
First Line	:	8201 S HOWELL AVE
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-8337
Country	:	US
Telephone Number	:	414-295-9045
Fax Number	:	414-240-3162

Authorized Official
Title or Position	:	CEO
Name	:	SHEILA GANSEMER
Credential	:
Telephone Number	:	414-325-4589

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	01/21/2025

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