Healthcare Provider Details

I. General information

NPI: 1083715676
Provider Name (Legal Business Name): NORTH SHORE ORTHOPAEDICS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 N PORT WASHINGTON RD
GLENDALE WI
53217-3422
US

IV. Provider business mailing address

7545 N PORT WASHINGTON RD
GLENDALE WI
53217-3422
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-3500
  • Fax: 414-351-9063
Mailing address:
  • Phone: 414-351-3500
  • Fax: 414-351-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES FLESCH
Title or Position: PRESIDENT
Credential: MD
Phone: 414-351-3500