Healthcare Provider Details

I. General information

NPI: 1225942592
Provider Name (Legal Business Name): WISCONSIN INSTITUTE OF AMBULATORY SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N LIGHTNING DR
APPLETON WI
54913-6735
US

IV. Provider business mailing address

4100 N LIGHTNING DR
APPLETON WI
54913-6735
US

V. Phone/Fax

Practice location:
  • Phone: 920-380-9890
  • Fax: 920-733-5610
Mailing address:
  • Phone: 920-380-9890
  • Fax: 920-733-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA SAUERHAMMER
Title or Position: OWNER
Credential:
Phone: 920-380-9890