Healthcare Provider Details

I. General information

NPI: 1538018445
Provider Name (Legal Business Name): NORTHSTAR ANESTHESIA OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8124 FORSYTHIA ST
MIDDLETON WI
53562
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 608-234-7436
  • Fax:
Mailing address:
  • Phone: 214-687-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L LUMBLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 617-935-5799