Healthcare Provider Details

I. General information

NPI: 1770920472
Provider Name (Legal Business Name): JONATHAN STONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W RAWSON AVE STE 200205
FRANKLIN WI
53132-9417
US

IV. Provider business mailing address

3077 N MAYFAIR RD STE 305
WAUWATOSA WI
53222-4305
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-6700
  • Fax: 414-761-1921
Mailing address:
  • Phone: 414-384-6700
  • Fax: 414-727-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number256175
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA153261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: