Healthcare Provider Details

I. General information

NPI: 1982641353
Provider Name (Legal Business Name): NORTHWOODS FAMILY ORTHOPAEDICS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 COPPER ST
HURLEY WI
54534-1345
US

IV. Provider business mailing address

200 E WASHINGTON ST P O BOX 8031
APPLETON WI
54911-5490
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-4795
  • Fax:
Mailing address:
  • Phone: 888-833-8200
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK S BALAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 715-561-4795