Healthcare Provider Details

I. General information

NPI: 1831102540
Provider Name (Legal Business Name): WISCONSIN BONE & JOINT S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH MAYFAIR RD SUITE 500
WAUWATOSA WI
53226
US

IV. Provider business mailing address

2500 NORTH MAYFAIR RD SUITE 500
WAUWATOSA WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-2525
  • Fax: 414-257-1772
Mailing address:
  • Phone: 414-257-2525
  • Fax: 414-257-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DALE E BAUWENS
Title or Position: PRESIDENT
Credential: MD
Phone: 414-257-2525