Healthcare Provider Details

I. General information

NPI: 1295776649
Provider Name (Legal Business Name): WAUKESHA SURGICAL SPECIALISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD ST SUITE 209
WAUKESHA WI
53188-3417
US

IV. Provider business mailing address

1111 DELAFIELD ST SUITE 209
WAUKESHA WI
53188-3403
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-0444
  • Fax: 262-542-8214
Mailing address:
  • Phone: 262-542-0444
  • Fax: 262-542-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER B DAVIES
Title or Position: PRESIDENT
Credential: MD
Phone: 262-542-0444