Healthcare Provider Details

I. General information

NPI: 1366473597
Provider Name (Legal Business Name): ASPEN ORTHOPEDIC AND REHABILATION SPECALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 W NATIONAL AVE STE 100
NEW BERLIN WI
53151-4061
US

IV. Provider business mailing address

12555 W NATIONAL AVE STE 100
NEW BERLIN WI
53151-4061
US

V. Phone/Fax

Practice location:
  • Phone: 262-395-4141
  • Fax: 262-395-4159
Mailing address:
  • Phone: 262-395-4141
  • Fax: 262-395-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN J. KEHOE
Title or Position: MD
Credential: MD
Phone: 262-395-4141