Healthcare Provider Details

I. General information

NPI: 1609230044
Provider Name (Legal Business Name): JACOB PFEIFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 W OAKWOOD PARK CT STE 110
FRANKLIN WI
53132-9565
US

IV. Provider business mailing address

2500 W LAYTON AVE STE 200
MILWAUKEE WI
53221-5434
US

V. Phone/Fax

Practice location:
  • Phone: 262-297-7246
  • Fax: 888-714-0578
Mailing address:
  • Phone: 262-297-7246
  • Fax: 888-714-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number69860
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: