Healthcare Provider Details

I. General information

NPI: 1497794465
Provider Name (Legal Business Name): HAND TO SHOULDER SPECIALISTS OF WISCONSIN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W RIVER WOODS PKWY STE 230
GLENDALE WI
53212-1010
US

IV. Provider business mailing address

525 W RIVER WOODS PKWY STE 230
GLENDALE WI
53212-1010
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-7418
  • Fax: 414-967-1151
Mailing address:
  • Phone: 414-453-7418
  • Fax: 414-967-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA C KLIMCZAK
Title or Position: MANAGER
Credential:
Phone: 414-453-7418