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General NPI Number Information
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NPI Number | 1265740302
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGERY OF BURLINGTON LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 1050 S MILWAUKEE AVENUE STE 102
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City | BURLINGTON
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State | WI
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Zip | 53105-1380
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Country | US
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Telephone | 262-763-9007
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Fax | 262-758-6134
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Provider Business Mailing Address
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Address Line | 1050 S MILWAUKEE AVENUE STE 102
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City | BURLINGTON
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State | WI
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Zip | 53105-1380
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Country | US
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Telephone | 262-758-6155
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL KOKAT
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Credential | D.P.M.
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Telephone | 262-763-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | WI
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