Healthcare Provider Details

I. General information

NPI: 1588623060
Provider Name (Legal Business Name): TRANSPLANT S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KINNICKINNIC RIVER PKWY #511
MILWAUKEE WI
53215-3677
US

IV. Provider business mailing address

PO BOX 1127
SHEBOYGAN WI
53082-1127
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3780
  • Fax: 414-649-3794
Mailing address:
  • Phone: 920-457-6750
  • Fax: 920-457-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RALPH FAIRCHILD III
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 920-457-6750