Healthcare Provider Details

I. General information

NPI: 1396774543
Provider Name (Legal Business Name): WISCONSIN SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST STE 150
MILWAUKEE WI
53215
US

IV. Provider business mailing address

PO BOX 210140 4131 W LOOMIS RD STE 300
GREENFIELD WI
53221
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2100
  • Fax: 414-384-2700
Mailing address:
  • Phone: 414-325-3725
  • Fax: 414-325-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VISHAL LAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-325-3737