Healthcare Provider Details

I. General information

NPI: 1447540463
Provider Name (Legal Business Name): SOUTH SHORE ORTHOPEDIC SURGERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9120 W LOOMIS RD STE 100
FRANKLIN WI
53132-9083
US

IV. Provider business mailing address

9120 W LOOMIS RD STE 100
FRANKLIN WI
53132-9083
US

V. Phone/Fax

Practice location:
  • Phone: 262-939-9318
  • Fax: 608-756-8617
Mailing address:
  • Phone: 262-939-9318
  • Fax: 608-756-8617

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: MS. CATHY J DEAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 262-939-9318