Healthcare Provider Details

I. General information

NPI: 1275127375
Provider Name (Legal Business Name): MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 S BALLPARK DR STE 100
FRANKLIN WI
53132-6908
US

IV. Provider business mailing address

PO BOX 1153
BEDFORD PARK IL
60499-1153
US

V. Phone/Fax

Practice location:
  • Phone: 414-817-6620
  • Fax:
Mailing address:
  • Phone: 414-817-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEILA GANSEMER
Title or Position: CEO
Credential:
Phone: 414-325-4589