Healthcare Provider Details

I. General information

NPI: 1619018819
Provider Name (Legal Business Name): MIDWEST SPINAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 E NEWPORT AVE SUITE 605
MILWAUKEE WI
53211-2949
US

IV. Provider business mailing address

2015 E NEWPORT AVE SUITE 605
MILWAUKEE WI
53211-2949
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-8600
  • Fax: 414-962-9947
Mailing address:
  • Phone: 414-962-8600
  • Fax: 414-962-9947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES E STOLL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 414-962-8600