Healthcare Provider Details

I. General information

NPI: 1861130148
Provider Name (Legal Business Name): MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W LAYTON AVE STE 202
MILWAUKEE WI
53221-2621
US

IV. Provider business mailing address

PO BOX 1297
BEDFORD PARK IL
60499-1297
US

V. Phone/Fax

Practice location:
  • Phone: 414-567-3022
  • Fax:
Mailing address:
  • Phone: 414-567-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHEILA GANSEMER
Title or Position: CEO
Credential:
Phone: 414-325-4589