Healthcare Provider Details

I. General information

NPI: 1417533993
Provider Name (Legal Business Name): OPTIMAL ORTHOPEDIC CARE S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7186 S 76TH ST
FRANKLIN WI
53132-9736
US

IV. Provider business mailing address

7186 S 76TH ST
FRANKLIN WI
53132-9736
US

V. Phone/Fax

Practice location:
  • Phone: 262-226-0688
  • Fax:
Mailing address:
  • Phone: 262-226-0688
  • 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: JAMES FOSKETT
Title or Position: OWNER
Credential:
Phone: 262-226-0688