Healthcare Provider Details

I. General information

NPI: 1891975801
Provider Name (Legal Business Name): UROLOGICAL SURGERY S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK RIDGE LN
NORTH FOND DU LAC WI
54937-1385
US

IV. Provider business mailing address

700 PARK RIDGE LN
NORTH FOND DU LAC WI
54937-1385
US

V. Phone/Fax

Practice location:
  • Phone: 920-907-7450
  • Fax: 920-907-7410
Mailing address:
  • Phone: 920-907-7450
  • Fax: 920-907-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number27851
License Number StateWI

VIII. Authorized Official

Name: RICHARD BROWNING WINDSOR JR.
Title or Position: OWNER
Credential: M.D.
Phone: 920-907-7450