Healthcare Provider Details

I. General information

NPI: 1174584478
Provider Name (Legal Business Name): MILWAUKEE HAND CENTER S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W MARKET ST
MEQUON WI
53092-5053
US

IV. Provider business mailing address

1535 W MARKET ST
MEQUON WI
53092-5053
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-9224
  • Fax: 262-241-9228
Mailing address:
  • Phone: 262-241-9224
  • Fax: 262-241-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number3576026
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number298026
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number37648
License Number StateWI

VIII. Authorized Official

Name: DR. GREG PETER WATCHMAKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-241-9224