Healthcare Provider Details

I. General information

NPI: 1629879440
Provider Name (Legal Business Name): NIESEN ORTHOPEDICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 W MAIN ST STE 102
SUN PRAIRIE WI
53590-3103
US

IV. Provider business mailing address

1777 W MAIN ST STE 102
SUN PRAIRIE WI
53590-3103
US

V. Phone/Fax

Practice location:
  • Phone: 608-577-1055
  • Fax:
Mailing address:
  • Phone: 608-577-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW C NIESEN
Title or Position: PRESIDENT
Credential: MD MHA
Phone: 608-577-1055