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General NPI Number Information
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NPI Number | 1225954696
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPORTS MEDICINE SPECIALISTS OF GREEN BAY, SC
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 614 MEMORIAL DR
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City | CHILTON
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State | WI
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Zip | 53014-1568
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Country | US
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Telephone | 920-430-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 2223 LIME KILN RD STE 1
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City | GREEN BAY
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State | WI
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Zip | 54311-6238
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Country | US
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Telephone | 920-430-8113
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDY FRAGALE
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Credential |
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Telephone | 920-965-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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