Healthcare Provider Details

I. General information

NPI: 1114566395
Provider Name (Legal Business Name): WISCONSIN ORTHOTICS & PROSTHETICS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2020
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 S 13TH ST STE 102
OAK CREEK WI
53154-1466
US

IV. Provider business mailing address

7071 S 13TH ST STE 102
OAK CREEK WI
53154-1466
US

V. Phone/Fax

Practice location:
  • Phone: 414-246-2151
  • Fax: 414-246-2224
Mailing address:
  • Phone: 414-246-2151
  • Fax:

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 TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ABDUL WALEED
Title or Position: PRESIDENT
Credential:
Phone: 414-246-2151