Healthcare Provider Details

I. General information

NPI: 1346164662
Provider Name (Legal Business Name): WISCONSIN CENTER FOR ORTHOPEDICS AND WELLNESS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 W LAYTON AVE
MILWAUKEE WI
53221-1500
US

IV. Provider business mailing address

10936 N PORT WASHINGTON RD # 126
MEQUON WI
53092-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-343-5931
  • Fax:
Mailing address:
  • Phone: 262-343-5931
  • Fax:

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. MATTHEW PAUL WICHMAN
Title or Position: OWNER/FOUNDER
Credential:
Phone: 414-338-7300