Healthcare Provider Details

I. General information

NPI: 1386647287
Provider Name (Legal Business Name): FORWARD ORTHOPEDICS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

V. Phone/Fax

Practice location:
  • Phone: 262-257-5860
  • Fax: 262-257-5858
Mailing address:
  • Phone: 262-257-5860
  • Fax: 262-257-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27105-020
License Number StateWI

VIII. Authorized Official

Name: GREGORY N VAN WINKLE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 262-257-5860