Healthcare Provider Details

I. General information

NPI: 1083529812
Provider Name (Legal Business Name): ORTHOPAEDIC HOSPITAL OF WISCONSIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W RIVER WOODS PKWY
GLENDALE WI
53212-1081
US

IV. Provider business mailing address

475 W RIVER WOODS PKWY
GLENDALE WI
53212-1081
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-6803
  • Fax: 414-961-6778
Mailing address:
  • Phone: 414-961-6803
  • Fax: 414-961-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SPIESS
Title or Position: CFO
Credential:
Phone: 414-961-6847