Healthcare Provider Details

I. General information

NPI: 1720433790
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF WISCONSIN SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 S ROCHESTER ST STE 100
MUKWONAGO WI
53149
US

IV. Provider business mailing address

N15W28300 GOLF RD
PEWAUKEE WI
53072-4800
US

V. Phone/Fax

Practice location:
  • Phone: 262-303-5055
  • Fax:
Mailing address:
  • Phone: 262-303-5055
  • Fax: 262-303-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: JON MICHAEL ENGLUND
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 262-303-5055